Provider Relations/Services Representative - Hybrid

Summary

Under the general direction of the Provider Network Operations (PNO) – Provider Network Management Supervisor, the In-House IPA Representative serves as the liaison between the IPA clients, IPA client’s contracted providers and health plan(s). They will be responsible for the executing the provider onboarding, update, and termination processes for the MedPOINT Management (MPM) managed client IPAs. The In-House IPA Representative ensures the timely and accurate update of provider information system/database, resolution of providers’ issues, State/health plan reporting, and improving all provider business experiences with their assigned IPA. They will interface with PNO, Credentialing, Utilization Management (UM) and other MedPOINT Management (MPM) departments to facilitate numerous processes, including but not limited to Credentialing assistance, UM coordination, contracting support, health plan communications, and Provider communications.

Duties and Responsibilities: 

• Maintain frequent, timelyand productive communication with IPA clients,providers, health centers,and health plans
• Performs PNO triage function; addresses issues and requests raised/submitted by providers and routes communications to the appropriate teams for successful resolution
• Assist in research of provider-related issues including demographic information, contracting status, credentialing status, claim issues and status in MPM client database
• Ensure accuracy amongassigned IPA profileswithin EZ-CAP database
• Maintain timelyand thorough communication with PNO Rate Configuration and Contracts, Credentialing and Compliance Teams on terminations and contract status changes for appropriate rate adjustments and recruitment, if needed
• Complete/Oversee specialprojects as they arise (e.g. ad-hoc healthplan, IPA clientsor provider requests)
• Participate in assignedIPA client’s standingand ad-hoc meetingsas needed
• Ensure HIPAA compliance is always observed/performed
• Understand and follow the MPM Employee Handbook policies and procedures
• Perform additional duties/assignments as needed

Minimum Job Requirements:

• High School Diplomaor GED required, Bachelor’s degreein healthcare or related field preferred
• 2+ years ManagedCare or Healthcare experience in ProviderNetwork Management, a plus
• Thorough understanding of provider networkmanagement processes
• EZ-CAP knowledge and experience required
• Proficient in MicrosoftOffice Suite (Word,Excel, PowerPoint, Outlook)

Skills and Abilities:

• Strong and consistent customerservice acumen with the abilityto resolve complaints and concerns
• Excellent attentionto detail, with the abilityto communicate and document information accurately
• Ability to multi-task, exerciseexcellent time management, and meet multiple deadlines
• Willingness take on and lead projectsoutside the normalscope of the job description
• Ability to provide and receive constructive job-related feedback
• Proven abilityto effectively analyzeinformation and think critically
• Ability to quicklylearn and use new softwaretools
• Demonstrate commitment to the organization’s core values

Salary Range:

• $20 - $26 hourly