Provider Relations Representative
On-siteOmaha, Nebraska, United States
Job Summary
Contract providers and essential vendors in current service areas to maintain CMS adequacy and ensure necessary services for Plan members. Insure providers meet credentialing requirements for appropriate service lines while educating them on Health Plan functions and roles. Conduct education presentations to ensure provider understanding and commitment, and monitor relationships to maintain network coverage across all areas. Complete corporate assignments as assigned and establish a positive work environment that encourages participation in process improvement. This role supports Institutional Special Needs Plans for seniors in long-term care facilities, partnering with nursing home operators to manage medical risk and reduce emergency visits.
Required Qualifications
- Fluency in all current provider payment methodologies including per diems, DRGs, and APCs
- Knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships
- Ability to accept instructions and work independently in the completions of goals and assignments
- Strong negotiation, organization, presentation and time management skills
- Ability to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals
- Ability to work effectively in a team environment
- Excellent computer skills, including Microsoft Office Suite
- Self-motivation, dependability, and goal-orientation
- Experience in the health care field
- Availability to work 8 a.m. until 5 p.m. local time
- Willingness to travel to network provider locations
- Bachelor's degree
Desired Qualifications
- Prior experience in network development / network services
- Prior experience with acute and post-acute facilities
- Prior experience with Medicare Advantage plans
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