Provider Relations Representative

ARCADIAN HEALTH PLAN

Position Description

 

Position Title: Provider Relations Representative – Prescott, Arizona

 

Division: Network Management

 

Direct Report: Executive Director

 

Position Description:

 

Provide primary internal, and external, support to the Executive Director in contracting, resolution of provider issues, initial claims research, provider projects, network performance monitoring and provider network communications. Act as the initial contact for, and maintain effective working relationships with, key individuals in provider and health plan organizations.

 

Principle Responsibilities:

 

1. Work directly with providers and provider groups to resolve issues relating to claims payment, eligibility, reporting and other issues as they arise and are referred/assigned by the Executive Director.

 

2. Effectively maintain a cordial professional relationship with key individuals of assigned provider organizations, individual provider offices and health plans.

 

3. Effectively communicate responses to providers and provider groups using both verbal and written communication skills.

 

4. Conduct provider education as required in regulatory requirements and training in existing, and new Desert Canyon Community Care systems/processes.

 

5. Work effectively with other DCCC departments and with the payers to obtain all information necessary to resolve provider issues.

 

6. Interface with the Service Center on claims payment discrepancies and follow until issues are resolved.

 

7. Work with Arcadian Network Specialist to enter and distribute information internally relating to physician changes, adds, terminations, etc. and quarterly distribution to appropriate physician groups.

 

8. On behalf of Utilization Management, and at the direction of the Executive Director, draft basic letters of agreement for specialty, ancillary or case specific needs.

 

9. Any other duties as required by Network Management.

 

Experience and Education:

 

Bachelors Degree with relevant managed care/health care experience. Strong verbal and written communication skills are required. PC skills are a must. Experience in claims processing and health plan operations preferred.  Some travel involved.