Provider Relations Representative

Martin's Point Health Care | Portland, ME

Posted Date 11/07/2019
Description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

The Provider Relations Representative has primary responsibility for maintaining provider networks that delivers clinical, financial, and service value to Martin’s Point USFHP and Generations Advantage members. The Provider Relations Representative is the departmental point of contact for internal and external customers relating to provider relations and network management. In partnership with Network leadership and Provider Relationship Managers, this role is responsible for maintenance of ongoing positive relationships with contracted providers (network management).

Network Management

  • Collaborate with Provider Relationship Managers to identify potential providers (by market, by specialty) including gap analysis
  • Collaborates with Provider Relationship Managers to recruit new providers
  • Acts as a liaison between internal departments to establish policies and procedures to maximize work flows
  • Identifies system and processing enhancements for Claims, HMD, Provider Inquiry, and Member Services
  • Maintains customer service tracker (specific to operational issues between claims, member services, provider inquiry) in coordination with customer service to enhance provider and member satisfaction
  • Assists Provider Relationship Managers or Director with preparation and presentation of departmental or plan audits and reviews, (e.g., CMS, NCQA)
  • Assists with claim inquiries through live call queue and logs calls/complaints into our contract system
  • Assists relationships with network providers to promote positive relationships and ensure contract compliance
  • Provide education to providers over the phone
  • Communicate with providers regarding substantial changes in benefits or program
  • Communicate with providers on complaints and other specific issues
  • Research and resolve provider issues presented by providers within accepted departmental timeframes
  • Identify opportunities and recommend actions to increase level of provider and provider staff satisfaction with Martin’s Point
  • Communicate network issues and opportunities to Health Plan Management
  • Facilitates improved work flows within the department and cross functionally
  • Maintain updates to our internal process manual and employee training manual
  • Manages live phone queue; assists with provider inquiries and logs calls/complaints into our contract system Salesforce
  • Manages internal and external Provider Relations email inbox
  • Ensures all provider applications are accurately completed and prepared for processing by Credentialing by ensuring provider CAQH status is current and up to date as appropriate with new/recredentialing provider applications.
  • Supports overall Network Management production work as needed (e.g., entering provider changes)

Education/Experience:

  • Bachelor’s degree or equivalent combination of education and work experience
  • 2+ Years experience in managed care preferred, preferably provider contracting and network management
  • Proficiency in Microsoft Word, Excel, and Access Office Products
  • Oral and written communication skills

Skills/Knowledge/Competencies (Behaviors):

  • Excellent interpersonal and communication skills
  • Ability to organize and execute multiple activities simultaneously
  • Problem-solving skills
  • Demonstrated and evaluated ability to work independently to meet goals
  • Strong collaboration skills
  • Data collection, presentation, and manipulation
  • Valid driver’s license (no restricted or suspended license)
  • Ability to travel up to 5% of the time with potential overnights

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org

Geographic Region
Greater Portland/Casco Bay
Industry
Healthcare

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