Provider Relations Representative

Provider Relations Representative page is loaded## Provider Relations Representative remote type:
Hybrid 1-2 Working Caregivers (Onsite 1 - 2 days) locations:
Worcester, MAtime type:
Full time posted on:
Posted Todayjob requisition :
R#
** Exemption Status:
** Exempt
* * Hiring Range:**$59,051.20 - $Please note that the final offer may vary within this range based on a candidate’s
** experience, skills, qualifications, and internal equity considerations**.
** Schedule Details:
** Monday through Friday
** Scheduled

Hours:

** 8:30am - 5pm
** Shift:
** 1 - Day Shift, 8 Hours (United States of America)
*
* Hours:

** 40
* * Cost Center:
** 99940 - 5876 Payer Contracting This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.# #
** Everyone Is a Caregiver
** At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other.

And everyone, in their own unique way, plays an important part, every day.

Performs a variety of duties to assist in ensuring effective provider customer service. Fosters positive working relationships with providers, health plan payer and practice/hospital staff with regard to health plan policies and procedures, quality improvement initiatives and improving overall physician relations. Maintains effective contact with physicians, hospital staff, and others fielding inquiries, as well as informal and formal office visits, etc.

I. Major Responsibilities:
1. Assists in identifying issues requiring intervention and or communication to physician offices and hospital staff such as, managed care and/or health plan referral requirements, health plan related administrative and operational procedures, and quality improvement initiatives.
2. Assists in resolving escalated provider issues based on standard policies and procedures while incorporating provider's feedback.
3. Assists in developing and implementing a communication plan and follows up on physician and staff concerns.  
4. Works with physician/office staff to address issues and concerns related to hospital and/or health plan initiatives, policies and procedures or overall educational areas of improvement by through on-going dialogue with physician and hospital office staff.
5. Assists in developing communications and educational tools for in service trainings, health plan forums, orientation updates, physician and office workshops, provider handbooks and news bulletins.
6. Reports issues requiring intervention.  Investigates causes for recurring problems and helps resolve hospital and physician issues.
7. Works with Physician Enrollment and Credentialing office to prepare information for credentialing committees relating to new physician applications  
8. Works with database applications for reporting and assists in developing new reports to accommodate business reporting needs.

II. Position

Qualifications:

License/Certification/

Education:

Required:

1. Bachelor’s degree in Business Administration or related discipline.

Experience/

Skills:

Required:

1. Two to three years of relevant Managed Care experience.  
2. Knowledge of managed care principles and database applications.
3. Excellent verbal and written communication skills.  Preferred:  
1. Knowledge of a variety of business applications software packages with proficiency in database software such as Access.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description.…