Provider Network Management Relations Service Associate
US-NM-Albuquerque
Careers (External)
Req #: 48485
Type: Full Time
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Overview: Now hiring a Provider Network Management Relations Service Associate Primarily responsible for supporting the Network Relations Service Executive. With limited supervision responds to and resolves complex issues related to daily operations. The Network Relations Service Associate assists with data collection and distribution of clinical quality measures to the provider network in accordance with PHP s quality and incentive programs. Ensures providers receive exceptional service when responding to inquiries. The position assures an exceptional provider experience in support of organizational service goals including provider satisfaction and retention through ongoing network relationship development and management. Acts as a resource and advocate for the provider network offering guidance, training, and problem resolution ensuring data integrity and compliance with regulatory and compliance standards How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community. At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members. Why Join Us * Full Time - Exempt: No * Job is based Rev Hugh Cooper Admin Center * Work hours: Days * Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees. Ideal Candidate * High School diploma or GED required. One to three years of experience in provider relations, provider contracting, claims processing experience, or customer service in a healthcare organization. Responsibilities: * Provides superior service to all network providers, assisting with resolution of provider issues regarding claims, health services, finance or other Health Plan related issues. This includes reporting, tracking and trending provider calls and complaints, meeting or exceeding service goals defined by organization and business unit, as well as recommending process improvements to enhance the overall service level to providers. * Responsible for initiating and processing provider changes including demographic, tax id and other related data corrections. Performs data entry as needed. * Responsible for ensuring provider data integrity and accuracy by completing PIF s timely and accurately. * Coordinates and assists with meetings, training, contracting, credentialing and reporting. * Develops and maintains positive provider relationships. * Collaborates with the Network Service Executive to provide leadership in Network Support Team Meetings, also accepts delegated responsibilities and assignments. * Assists Network Service Executive with daily issues or concerns, researches complex issues, provides documentation and recommendations for resolutions. * Acts as a resource to the assigned network for questions or guidance on compliance concerns or other health-plan related issues. Acts as advocate for the assigned network providers assisting with the interpretation of contracts and other related reimbursement issues. * Engages and supports leadership and peers by promoting and participating in department initiatives and being accountable for achieving business objectives. * Practices respecting and valuing the differences in each person and demonstrates an inclusive style that fosters dialogue for collaborative solutions Qualifications: * High School diploma or GED required. One to three years of experience in provider relations, provider contracting, claims processing experience, or customer service in a healthcare organization. * Superior oral, written, interpersonal skills required to interface with providers and the providers staff. * Must also have strong organizational and personal computing skills
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