Healthcare Provider Relations Specialist I

20 Driscoll Children's Health Plan; Corpus Christi (TX); On-site; USD 52,000 - 76,000; Full time

Job summary

Driscoll Health Plan in Corpus Christi, TX is seeking a Provider Relations Representative to serve as the liaison between health care providers and the plan. You will conduct initial orientations, ongoing education, and routine site surveys to ensure open communication and up-to-date provider demographics in your territory.

The role focuses on educating providers on contract requirements, claim submission, and portal functions, while building strong relationships and resolving issues.

Qualifications

• Licensure: Valid driver's license required.
• Two years' experience in healthcare, medical provider or customer relations.
• Minimum of 3 years' experience in a Provider Relations role, preferably with a health plan or provider network.
• At least a high school education with college degree preferred.

Responsibilities

• Maintains utmost level of confidentiality at all times.
• Adheres to hospital and Health Plan policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Communicates the benefits of being a DHP provider.
• Provides timely education to providers and provider's staff concerning contract requirements, DHP provider manual, policies and procedures, and claim submission guidelines.
• Provides timely education to providers and provider's staff on DHP electronic submission of claims, Electronic Funds Transfer processes, and web portal functions.
• Establish good working relationships with providers and provider offices in resolving issues to include being a trusted advocate for the provider.
• Establish a schedule of provider workshops to include specialty specific education.
• Assists providers with incentive programs, as applicable.
• Develop and implement a balanced scorecard metric.
• Assist the Contracting and Credentialing Departments as necessary.
• Document provider calls to include an Issues Log for monthly reporting.
• Develop and maintain a process for provider notification to include physician changes (moves, leaves practice, join practice, etc).
• Communicates in both written and oral form with contracted professionals, individuals, on behalf of the physicians/Health Plan in order to obtain or relay information.
• Maintains up to date knowledge of physician contracts, claims and billing.
• Is detail oriented with exceptional presentation skills, ability to complete multiple projects and meet deadlines.
• Maintains excellent verbal and written communication skills, proficient computer skills helpful.
• Ability to provide prompt, courteous and excellent customer service to providers.
• Assists the CEO, CFO, Medical Director's). Directors, or other staff as needed.
• Performs other duties as requested.

Skills

Strong written and verbal comms

Persuasion

Problem solving

Prioritization

Professional demeanor

Education

High school diploma or equivalent

Valid driver's license

Tools

Microsoft Office

Job description

Driscoll Health Plan in Corpus Christi, TX is seeking a Provider Relations Representative to serve as the liaison between health care providers and the plan. You will conduct initial orientations, ongoing education, and routine site surveys to ensure open communication and up-to-date provider demographics in your territory.

The role focuses on educating providers on contract requirements, claim submission, and portal functions, while building strong relationships and resolving issues.