Provider Consultant

Comprehensive pay range: $65,000.00/yr – $78,000.00/yr. Actual pay will be based on skills and experience. Consult your recruiter for details.

• Serve as the primary liaison between the Healthcare Network and the participating provider community that serves our members across multiple product lines.
• Build and maintain strong relationships with providers by offering excellent customer service to assigned primary‑care and specialty‑care physicians, including routine and targeted education visits to continue education regarding policies and initiatives. Service also includes supply deliveries and prompt follow‑up regarding claims, benefits, and procedural guidelines for authorization of services.
• Conduct on‑site visits, telephonic conversations, and written communications with individuals including hospital executives, patient account managers, physicians, office and billing managers.
• Perform on‑site provider orientations and group county orientations for new primary‑care and specialty‑care physicians regarding policies, procedures, billing and company‑wide initiatives.
• Represent the Provider Consultant Department in work groups and committees that address internal and external customer concerns regarding the operations of the Healthcare Network as it pertains to the provider community.
• Other duties as assigned.
• Applicant must be highly proficient and creative at identifying and solving problems.

Incumbent must be able to work independently as a telecommuter and attend off‑site meetings, including overnight stays.

• Communicate effectively as a liaison between the provider community and PBACO to provide education on policies and procedures and assist in resolving issues or concerns a provider may have.
• Perform on‑site provider orientations for primary‑care and specialty‑care physicians regarding policies, procedures, billing and company‑wide initiatives within 30 days of becoming credentialed and approved.
• Oversee group county provider orientations by determining location, arranging for mailing of invitations, and providing PBACO provider forms, QI manuals, directories and the PBACO Provider Office Policy and Procedure Manual, as needed.
• Goal/Target Visits:
  Serve primary‑care and specialty‑care physicians within a specific geographic territory by conducting annual goal/target visits for continued education regarding policies and initiatives. Each Provider Consultant will schedule at least one goal visit per year with participating practices in the following specialties:
  Primary Care / Specialists.

• 2 years’ experience required in provider relations and/or managed‑care product administration.
• Valid unrestricted driver’s license.

• Bachelor’s degree in Business Administration, Marketing, Health Care Administration or a related field.
• 2 years’ experience in provider relations or medical office or hospital experience.
• 2 years’ exposure to medical claims processing procedures.
• Knowledge of and understanding of the dynamics of the managed‑care environment, including capitation and reimbursement structure.

The position requires driving for extended periods, walking to and from provider offices, and potentially going up and down stairs.

Entry level

Full‑time

Consulting, Information Technology, and Sales

Hospitals and Health Care