Provider Relations Rep II in Linthicum Heights, MD at Beacon Health Options

Date Posted: 9/18/2018

Job Snapshot

Job Description

About The Position:

Under the general supervision of the Manager of Provider Relations, the Provider Relations Representative II routinely interfaces with existing providers and providers’ office staff to develop a solid business relationship. Conducts outreach to providers to assist in education of Beacon policies and procedures or to resolve issues.  He/she coordinates, develops and processes a multitude of reports related to the provider network. Assists Manager in conducting provider meetings, education and training classes, as well as, any special projects.  Establishes timely action plans and guidelines to service new and current providers, assists with network development, investigates non-standard requests and problems, and provides explanations and information to others on topics within area of expertise. 

Position Responsibilities:

  • Act as a resource for providers about Beacon, its contracts, policies and procedures. Provide accurate and timely responses to provider inquiries, issues and requests.
  • Regularly interact and establish solid working relationships with Customer Service, Clinical, Claims, Network Operations, IT and Contracting in resolving provider and other operational issues.
  • Remain current on regulatory and company policy that impacts the provider network and related issues.
  • Engage providers in Beacon’s quality improvement activities.
  • Help to secure completed contracts and credentialing materials from key providers who have been invited to join the network.
  • Strategize with members of the management team to ensure access and availability of providers meets current standards.
  • Be the liaison between providers and other Beacon departments.
  • Plan and facilitate trainings using various technology solutions, including new applications and procedures.
  • Lead classroom-style training sessions remotely, in-person and via WebEx/video conference.
  • Conduct provider site visits and other audits to ensure provider compliance with Beacon policies and NCQA accreditation standards.
  • Strategize with members of the management team to ensure access and availability of providers meets current standards.
  • Participate in development and maintenance of plans to meet performance guarantees.
  • Assists in the identification of service level gaps and works with Manager of Provider Relations and Contracts Managers to address recruitment opportunities
  • Prepare reports and analyze data as directed by the Manager of Provider Relations or other members of the management team.
  • Solid technical writing skills with a demonstrable ability to translate technical jargon and information into business-friendly language.
  • Manage multiple, simultaneous, and complex projects. 

Position Requirements:

  • Education: High school diploma or GED required.  Bachelor’s degree preferred.
  • Relevant Work Experience and General Competencies: Minimum 3 years’ experience in the HealthCare field.

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