Job Title: Provider Relations Rep .
Location: VA - Charlottesville .
Employment Status: Full Time .
Job Requisition Number: 35459 .
External Description:
Provider Relations Representative -- This position will service Northern
Virginia doctors and will be located either in the Charlottesville office or
work from home in the Northern Virginia area.
GENERAL SUMMARY
Responsible for maintaining working relationships with the existing network. May
assist in the recruitment and credentialing of new providers. Maintains accurate
and current provider databases relating to provider facilities and physician
information. Assists with policy and procedure interpretation, assessment of
training needs and development and implementation of training programs.
ESSENTIAL RESPONSIBILITIES
- Assists in the basic operations of the Provider Relations Department.
- Provides service to provider practices by resolving problems and advising
providers of new protocols, policies and procedures.
- May assist in negotiating, reviewing, and preparing draft agreements with
alternative delivery system facilities, laboratories, and group practices.
- Assists with the development and monitoring of provider contracts.
- Resolves administrative problems affecting network providers, patients, and
plans within contracted guidelines for which responsible.
- Assures the provider documentation is complete and accurate. Ensures the
accuracy of provider data entered into the provider database.
- Researches and coordinates the resolution of provider's claims and capitation
issues.
- Coordinates provider status information with member services and other plan
departments.
- Performs other duties as required.
JOB SPECIFICATIONS
- Bachelor's degree or equivalent experience.
- Significant experience (usually 3+ years) with a combination of exposure to
benefits interpretation and provider networking.
- Substantive knowledge of managed care policy and direction.
- Knowledge of ICD-9 and CPT codes desired.
- Strong analytic and problem solving abilities.
- Strong communication and negotiation skills.
Applicant Category: Professional
Requisition Code: Work at home
Two Initials of Recruiter: bw
System Date: 03/29/2007
System Time: 11:36:02
Document Name(40): Provider Relations Rep
Source: CareerJournal - USA
SearchTerms: "work at home" "work from home"
URL(80): http://cj.careercast.com/texis/jobsearch/details.html?id=460342b76d650&q=%22work
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