Provider Relations Representative II in New York, NY at Beacon Health Options

Date Posted: 10/2/2018

Job Snapshot

Job Description

About The Position:

The Provider Relations Representative will provide the highest quality of service to providers and internal & external customers by maintaining proper standards for provider and customer interactions.  Ensure provider and customer satisfaction and represent the organization in a positive, professional manner in all interactions.  Make sure all assistance is supportive of corporate, service center and contractual goals and objectives and promote a positive corporate public image. Responsible for various levels of activities supporting the recruitment, credentialing and contracting process for potential and current Beacon Health Options providers.  Responsibilities may range from maintenance support, provider education and communication with internal customers and Beacon Health Options providers, to reviewing provider files/programs and monitoring program compliance with applicable standards and regulations.    Provide internal support and follow-through in completion of the Provider Relations functions.  Support provider relations staff by providing research, problem resolution, administrative support and follow-up on a variety of provider issues that may arise.  Coordinate activities with other internal Beacon Health Options departments to provide optimal customer service to network providers and internal customers.  Special projects and other duties as assigned.

Position Responsibilities:

  • Recruitment and Network Monitoring – Research and identify new providers for recruitment into the Beacon Health Options provider network. Initiate written and/or telephonic requests to providers for credentialing information.  Responsible for the coordination and implementation of activities necessary for the identification, review and selection of mental health, substance abuse treatment, EAP, and disability providers in support of Beacon Health Options network development
  • Research and Problem Resolution – Perform 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. Request reports for network management.  Review and analyze provider information and status through database queries.  Regularly review all network management reports (i.e.  denial reports, disenrollment grids, pend reports, credentialing status reports) and research information regarding providers and the area(s) served. Research files and databases to address provider questions.  Resolve customer/member/provider claims issues through investigation and problem solving. Follow-up on inquiries as needed, referring problems to other appropriate Beacon Health Options personnel as identified. Respond to provider rate increase requests through research, provider follow-up and rate increase request submission.
  • Customer Service – Perform responsibilities and tasks in ways which promote good will, build positive relationships, preserve human dignity and contribute positively to the service commitment of the Company. Service calls in a professional and courteous manner.  Work closely with Network Operations team to ensure seamless customer service to providers.  Interface with CSRs, Care Managers, Claims staff, account management and other service center staff to give information about provider contract/credentialing status to facilitate claims payment and referrals.  Interface with external and internal customers to ensure optimal efficiency of service. Address concerns of dissatisfied and/or angry customers and providers in a diplomatic manner. Respond to customer inquiries professionally and efficiently. Assist in day to day department activities including phone coverage and file maintenance.
  • Administrative Support – Obtain, process, manage and maintain both hard-copy and computer based provider information necessary for network development and maintenance activities.  Participate in the maintenance for files within a national database of potential and existing network providers.  Attend all staff meetings, team conferences and in-services as directed.  Maintain daily logs for future reference and analysis as well as document inquiries and complaints appropriately in ServiceConnect and other applicable databases.  Enter data accurately and timely into systems.  Perform routine clerical functions including filing, copying, faxing, typing and record retrieval.

Position Requirements:

  • Education: High School Diploma, Associate or BA/BS preferred.  
  • Relevant Work Experience: At least three years of experience in customer service, claims, auditing or provider relations in the behavioral health or managed care setting. Knowledge of and experience in provider benefits administration/health care setting. Knowledge of and experience with providers and provider networks.  Knowledgeable in DSMIV and ICD-9 coding, Revenue codes, CPT and HCPCS codes.

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