Provider Consultant

ADP, Inc.; Port Charlotte (FL); On-site; USD 60,000 - 82,000; Full time

Job summary

The Healthcare Network seeks a Provider Relations professional to act as primary liaison between the network and provider community, delivering education and support to physicians and office staff. The role emphasizes strong relationship building, on-site visits, and timely follow-up on claims, benefits, and authorization procedures.

The incumbent will work remotely, attend off-site meetings as needed, and travel as required, staying aligned with PBACO initiatives and group policy updates.

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

Responsibilities

• Serve as liaison between The Healthcare Network and the provider community to educate on policies and procedures.
• Provider Orientations: perform on-site orientations for primary care and specialty physicians within 30 days of credentialing.
• Oversee group county provider orientations by arranging location, invitations, and supplies as needed.
• Conduct annual Goal/Target visits with practices to promote policy education and initiatives.
• Represent the Provider Consultant Department in workgroups addressing provider concerns.

Skills

Provider relations

Customer service

Education visits

Relationship building

Education

Bachelor's degree

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.