Provider Consultant

Palm Beach Accountable Care Organization; Murfreesboro (TN); On-site; USD 60,000 - 85,000; Full time

Job summary

Palm Beach Accountable Care Organization is seeking a Provider Relations professional to act as a primary liaison between the network and provider community. The role involves outreach, education on policies, and resolving issues while supporting on-site and telecommuter work arrangements.

Responsibilities include conducting provider orientations, coordinating group county events, and performing annual goal/target visits with primary care and specialty physicians to promote policy initiatives.

Qualifications

• 2 years’ experience required in Provider Relations and/or Managed Care Product Administration.
• Valid unrestricted driver’s license.
• Bachelor’s degree in Business Administration, Marketing, Health Care Administration or Other Related Degree.
• 2 years’ Provider Relations experience or medical office or hospital experience.
• 2 years’ exposure to medical claims processing procedures.
• Knowledge and understanding of the dynamics of Managed Care environment, including capitation and reimbursement structure.

Responsibilities

• Serve as a liaison between the provider community and PBACO to educate on policies and procedures and resolve issues.
• Provider Orientations: on-site for primary care and specialty physicians regarding policies, billing and initiatives.
• Oversee group county provider orientations and distribute PBACO forms and manuals as needed.
• Conduct annual Goal/Target visits with primary care and specialists to discuss policies and initiatives.
• Represent the Provider Consultant Department in workgroups addressing provider concerns.
• Other duties as assigned and solve problems independently while telecommuting.

Skills

Provider relations experience

Managed Care Administration

Education

Bachelor’s degree in Business Administration/Marketing/Health Care Administration

Job description

This position is responsible for the following:

• Serve as the primary liaison between The Healthcare Network and the participating provider community who service our members in multiple product lines throughout the network.
• Build and maintain strong relationships with providers by offering excellent customer service to assigned primary care, and specialty care physicians with routine and targeted education visits for the purpose of continued education regarding policies/initiatives. Service also includes supply deliveries and prompt follow up regarding claims, benefits and procedural guidelines for authorization of services.
• Conduct on-site visits, telephonic conversations and written communications with individuals including Hospital executives, Patient Account Managers, Physicians, Office and Billing Managers.
• Perform on-site provider orientations and group county orientations for new primary care, and specialty care physicians regarding policies, procedures, billing and company-wide initiatives.
• Represent the Provider Consultant Department in workgroups and committees that address both internal and external customer concerns regarding the operations of The Healthcare Network as it pertains to the provider community.
• Other duties as assigned.
• Applicant must be highly proficient and creative at identifying and solving problems.

Incumbent must be able to work independently as a telecommuter and attend off-site meetings, including overnight stays.

Essential Job Functions:

• Communicate effectively as a liaison between the provider community and PBACO in order to provide education on policies and procedures as well as, to assist in the resolution of issues or concerns a provider may have.
• Provider Orientations: Perform on-site provider orientations for primary care, specialty care physicians regarding policies, procedures, billing and company-wide initiatives within 30 days of becoming credentialed and approved.
• Oversee group county provider orientations by determining location, arranging for mailing of invitations and make available at the presentation PBACO provider forms, QI Manuals, directories and the PBACO Provider Office Policy and Procedure Manual, as needed.
• Goal/Target Visits: Service primary care, and specialty care physicians within a specific geographic territory by conducting annual Goal / Target visits for the purpose of continued education regarding policies/initiatives. Each Provider Consultant will schedule minimally one goal visit per year with participating practices in the following specialties: Primary Care / Specialists

Minimum Qualifications:

2 years’ experience required in Provider Relations and/or Managed Care Product Administration

Valid unrestricted driver’s license

Preferred Qualifications:

Bachelor’s degree in Business Administration, Marketing, Health Care Administration or Other Related Degree

2 years’ Provider Relations experience or medical office or hospital experience

2 years’ exposure to medical claims processing procedures

Knowledge and understanding of the dynamics of Managed Care environment, including capitation and reimbursement structure.

Physical Demands/Requirements:

The position requires driving for extended periods of time, as well as walking to and from provider offices potentially up and down stairs.