Provider Network Rep

This person will be a primary contact for providers. They will schedule, organize and facilitate collaborative JOC meetings as needed. They will perform provider orientations for individual providers and large provider groups. They will also provide ongoing education for these providers. They will travel to provider’s offices, so they must have a driver’s license.

**Everything in bold was added by the hiring manager** 

Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate. Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.

·  Serve as primary contact for providers and act as a liaison between the home and community based services providers and the health plan

·  Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and  research claims issues on-site, where possible, and route to the appropriate party for resolute

 Schedule, organize and facilitate collaborative JOC meetings as needed.

·  Receive and effectively respond to external provider related issues

·  Provide education on health plan’s innovative contracting strategies

·  Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network

·  Investigate, resolve and communicate provider claim issues and changes

·  Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation, MMP updates and related topics

·  Perform provider orientations for individuals, large diverse provider groups and ongoing provider education for same, including writing and updating orientation materials which you will present.

·  Ability to travel