Provider Relations Coordinator

Provider Partners Health Plan; United States; Remote; USD 50,000 - 70,000; Full time

Job summary

A Medicare Advantage HMO plan is seeking a Provider Relations Coordinator to enhance support for its management team. The role involves problem resolution, claims assistance, and provider education. Ideal candidates will have healthcare experience and a strong understanding of Medicare and Medicaid.

Qualifications

• Experience in a healthcare environment, preferably HMO/PPO.
• Strong communication skills and ability to work with providers.

Responsibilities

• Assist providers with problem resolution and claims issues.
• Input of providers into Salesforce.
• Reach out to contract new providers.

Skills

Customer service leadership

Problem resolution

Knowledge of Medicare and Medicaid programs

Understanding of managed care industry

Education

Bachelor’s Degree Preferred

High School Diploma or GED Required

Tools

Salesforce

Job description

Provider Relations Coordinator

Provider Partners Health Plan (Provider Partners) is a Medicare Advantage HMO plan for individuals enrolled in Medicare who reside in long-term care facilities. Provider Partners is truly something new – a Special Needs Plan run by a team of highly experienced long-term care providers that work with physicians, hospitals, and other providers to improve the quality of care and outcomes for its members. Patients and their families appreciate the extra, personalized touch offered in facilitating communication and care delivery among all the providers involved in their care.

Provider Partners offers a service product that greatly improves the life of others. We are searching for a results-oriented individual, with a proven track record, who is passionate about our mission and can generate positive outcomes based on that mission. If this is you, come be part of our elite team as a Provider Relations Coordinator. Reporting to the Manager of Provider Relations, the Provider Relations Coordinator will play a key role in providing operational support to the provider management team.

Primary Role and Responsibilities:

• Assist providers with problem resolution and claims issues.
• Assist with member claims issues.
• Input of providers into Salesforce
• Ancillary and PCP education and re-education
• Responses to member inquiries
• Claims utilization reporting through operations
• Beacon and Health Axis ticket analysis
• Upload new agreements into Salesforce.
• Consolidate provider rosters as needed.
• Ensure that Health Axis has updated provider information.
• Work the Pre-Check Run for Non-Par Providers
• Reach out to contract new providers.
• Assist with the plan growth and contracting.
• Other duties as needed.

Qualifications

• Bachelor’s Degree Preferred, High School Diploma or GED Required
• Experience working in a health care environment, preferably an HMO/PPO
• Customer service leadership experience preferred.
• Must have a working knowledge of Medicare and Medicaid programs.
• Must have a solid knowledge and understanding of the managed care industry.