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Provider Relations Representative

Company: GlobalHealth, Inc.
Location: Oklahoma City
Posted on: February 23, 2021

Job Description:

WHO WE ARE:As an industry leader, GlobalHealth is an Oklahoma-Based health insurer covering individuals in all 77 counties. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing--high touch,--high value--and a--partnership--to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company - we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.HOW WILL THIS POSITION ADD VALUE TO THE ORGANIZATION?The successful candidate will be responsible for provider performance through building relationships with providers and analyzing--data to provide meaningful--and impactful insight in order to develop--action plans. Previous experience working in this capacity is required.ESSENTIAL JOB FUNCTIONS:* Leads practice transformation with providers--engaged in GlobalHealth's value-based payment models * Manages provider relationships to achieve performance in various types of financial arrangements including fee for service, capitation, value-based and shared savings. * Monitors provider performance utilizing both claims utilization and cost-per-unit trends and develops action plans to achieve shared goals.* Leads provider engagement, cultivates relationships and executes network strategies.* Evaluates provider indicators with Provider Information Management (PIM) ensuring accurate provider-level reporting. * Assists in Joint Operating Committee (JOC) meetings with providers and facilities.* Works with Leadership to meet network adequacy including service area expansions.* Evaluates the provider network to ensure appropriate access and availability for Health Plan membership including managing panel status.* Educates providers including initial and ongoing training in the managed care program including applicable CMS updates and quality standards.* Respond timely to internal and external provider related inquires via Jira, Provider Relations email, CRMs and surveys.* Responds to second level claims appeals and reconsiderations to achieve resolution.* Assists in the maintenance of accurate Provider/Vendor records and Provider Directory.* Adheres to provider network policies meeting applicable NCQA, CMS, and company guidelines.* Maintains confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.* Perform other duties as assigned.EDUCATION AND EXPERIENCE:* Bachelor's degree in Business or Health Care Administration or equivalent experience required* Three years of experience in a managed care environment required* Previous provider relationship management, negotiation or medical sales experience preferredKNOWLEDGE, SKILLS AND ABILITIES:* Excellent verbal and written skills* Strong presentation skills both internally and externally* Interpersonal Skills - Ability to quickly develop rapport and work effectively and professionally with all levels of personnel* Problem-Solving Skills - Ability to investigate/research problems and issues and to recommend associated corrective actions* Discretion - Ability to manage sensitive or confidential information in a professional and discreet mannerWORK ENVIRONMENT:* Work is normally performed in a climate-controlled office environment, where exposure to conditions of extreme heat/cold, poor ventilation, fumes and gases is very limited.--Noise level is moderate and includes sounds of normal office equipment (computers, telephones, etc.).* Work involves standing and walking for brief periods of time, but most duties are performed from a seated position.--Work may include occasional pushing and/or pulling, lifting, and carrying objects weighing up to 20 pounds such as files, documents, and computer printouts.--Work normally requires finger dexterity and eye-hand coordination to operate a computer keyboard at moderate skill level.TRAVEL:Daily local travel up to 75% of the time requiredSUPERVISORY RESPONSIBILITY:This position has no supervisory responsibilities.OTHER DUTIES:This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Keywords: GlobalHealth, Inc., Oklahoma City , Provider Relations Representative, Other , Oklahoma City, Oklahoma

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