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Provider Relations Manager in Washington, DC at Beacon Health Options

Date Posted: 1/28/2019

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Provider Relations Manager to join our team at our office in Linthicum, MD/Washington D.C!  The Provider Relations Manager will manage relationships with providers in the geographic area of responsibility and advocate for resolution of issues.  Performs provider outreach and proactive personal contact with providers in their offices and through attendance at professional gatherings.  Provides education and brings provider feedback to the local, regional or corporate office for action.  Recruits new providers and works to maintain satisfaction of providers to prevent dis-enrollment.   NOTE: Corporate had stated they wanted this function to remain at their level. Conducts provider office site visits.  Works closely with regional and corporate Provider Relations staff to efficiently deliver services. Provides some administrative and operational support for the Trusted Health Plan account.

Position Responsibilities:

Recruits new individual and group practitioners and facilities to join the provider network for Beacon Health Options.

  1. Identifies potential practitioners through independent research, network inclusion requests, or attendance at professional gatherings, and performs preliminary screening and office visits.
  2. Ensures demographic information and facility POCs are accurate by verifying during each provider/facility contact, send Provider education materials and administrative updates using various mediums. Forward all other demographic changes, contracting and credentialing inquiries and supporting documentation to the appropriate corporate Provider Relations team.
  3. Maintains up to date knowledge of Beacon Health Options' policies, processes, and programs. Be familiar with any contract changes that affect behavioral health. Answers provider/facilities questions regarding Beacon Health Options' policies and procedures.
  4. Performs practitioner and facility orientation and training of office staff on Beacon Health Options' policies and procedures and provides updated training throughout the lifecycle of the provider relationship.
  5. Coordinates with other internal Beacon Health Options' departments (e.g. clinical) to ensure key operational areas are aware of any provider re-education or training needs.
  6. Performs provider and facility outreach to manage the ongoing relationship, and is a critical interface link with regional and corporate provider relations and network operations staff in the seamless delivery of services to providers including:
  7. providing feedback to providers regarding their performance under the terms of their contract;
  8. identifying and addressing quality of care and service issues, in conjunction with clinical and medical departments;
  9. Responding to provider complaints and questions as they arise;
  10. Identifying the need for provider mailings/communications.
  11. Sending providers educational materials and yearly fee schedule.
  12. Maintains a regular schedule of provider meetings (may be face to face or telephonic) with high volume and key network providers to maintain a high level of customer service.
  13. Conducts provider site visits and completes site-visit tool to ensure providers are compliant with standards established by the District of Columbia.
  14. Travels throughout Provider Relations Network -DMV area (50%).
  15. Provides administrative support to DC local team. This would include but not limited to following up on all return mail; ordering supplies; producing comprehensive reports, deliverables and  presentations; some member contact, as necessary

Position Requirements:

Education: Bachelor's degree in a related area.

Relevant Work Experience: At least three years of experience in provider relations, customer service, claims auditing   preferably in a managed behavioral health care setting required.


TO APPLY

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

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