PROVIDER RELATIONS REP I in Cypress, CA at Beacon Health Options

Date Posted: 7/10/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Provider Relations Representative I to join our team at our office in Cypress, CA. Provides internal support and follow-through in completion of the Provider Relations function. This position supports the local Director of Provider Relations by providing research, problem resolution and follow-up on a variety of provider issues that may arise.  The job also coordinates activities with other internal Beacon Health Options departments to provide optimal customer service to network providers and internal customers.

Position Responsibilities:

Commercial Contract

  1. Performs research and problem resolution on issues related to provider complaints, claims reported to have been processed incorrectly, coordinating credentialing paperwork, provider communications, or verification of information as requested

  2. Answers provider questions about Beacon, its contracts, policies and procedures

  3. Maintains a collaborative relationship with the operations, business personnel and provider community to incorporate process-related information into the training curriculum.

  4. Remain current on regulatory and company policy that impacts the provider network and related issues.

  5. Acting as a resource for providers on an ongoing basis to answer questions and resolved issues as they arise and act as a liaison between providers and other Beacon departments.

  6. Answers practitioner/facility recruitment questions regarding Beacon policies and procedures

  7. Identifying and soliciting providers based on network need for new and existing business.

  8. Provides assistance in compilation and mailing of provider recruitment mailings, general information, and educational materials to network practitioners as required

  9. Provides follow up with practitioners and facilities for the return of completed credentialing and re-credentialing applications

  10. Securing completed contracts and credentialing materials from providers who have been invited to join the network.

  11. Works closely with regional Network Operations team to ensure seamless customer service to providers

  12. Provide general support to all Network development activities.

  13. Adheres to all Beacon policies and procedures and standards of operations.

  14. Completes all required and assigned trainings.

  15. Attend all mandatory company or department meetings.

  16. Report to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.

  17. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.

  18. Performs special projects and other duties as assigned and required

Government Contract

  1. Responding to provider calls on the Provider Services Line queue as well as emails, voicemails and faxes seeking assistance

  2. Acting as a resource for providers on an ongoing basis to answer questions and resolved issues as they arise and act as a liaison between providers and other Beacon departments.

  3. Answering provider questions about Beacon, its contracts, policies and procedures

  4. Responds to provider inquiries and requests for Beacon written materials

  5. Actively outreaches and trains providers to increase the rate of electronic transactions through training and education

  6. Identifies and resolves provider issues by researching causes and working with Beacon’s clinical, operations and IT teams

  7. Performs active outreach to ensure compliance with access and availability

  8. Works with providers and network operations to ensure provider data submission and accuracy

  9. Participating in the coordination and processing of all Network department mailings

  10. Reviews claim reports for denial rates and works with providers to improve claim submissions

  11. Builds collaborative relationships with client health plan counterparts

  12. Processes and responds to providers interested in joining Beacon’s network

  13. Assists in the identification of service level gaps and works with Manager of Provider Relations and Contracts Managers to address recruitment opportunities

  14. Assists with network reporting activities

  15. Remain current on regulatory and company policy that impacts the provider network and related issues\ Lead classroom-style training sessions remotely, in-person and via WebEx/video conference

  16. Adheres to all Beacon policies and procedures and standards of operations.

  17. Completes all required and assigned trainings.

  18. Attend all mandatory company or department meetings.

  19. Report to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.

  20. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.

  21. Performs special projects and other duties as assigned and required.

Position Requirements:

Education: High School diploma or GED required.  Bachelor’s degree preferred.

Licensure: 

Relevant Work Experience:   Minimum 2 years’ experience in the HealthCare field.

Knowledge, Skills & Abilities:

  1. Customer Service experience required; provider relations experience required.

  2. Very strong verbal and written communication skills.

  3. Must be detail oriented and able to work independently in a fast changing environment.

  4. Strong understanding of managed care and health care operations.Behavioral health experience preferred.

  5. Must be able to work collaboratively with internal staff and external providers.

  6. Must be well organized. Requires excellent communication and writing skills.

  7. Have a professional demeanor and good public relations abilities.

  8. Advanced level of PC skills required in Word and Excel. 

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

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