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ResponsibilitiesThe Provider Relations Representative is responsible for establishing and maintaining positive relationships with various clients building strong, cohesive business partnerships.
$24.96 - $34.31 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Manager of Provider Relations will serve as the point person for managing the day-to-day relationship between MetroPlusHealth and top level administrators at each assigned network facility and community providers.
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Provider Relations Representative works as the primary liaison between Community First Health Plans and network participants (physicians, providers, and administrators) of the health plan provider network.
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Recent experience as a provider relations representative, member service representative, or relevant claim experience is highly preferred. The Provider Relations Representative knows and abides by all organizational and departmental policies, sets personal standards, and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.
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In collaboration with the HR Team, the Labor and Employee Relations Manager will also assist in providing “Level One” help to PAGNY provider in the absence of the HR Generalist, CAO or other staff on issues including, but not limited to CMEs, health and retirement benefits, payroll (e.g., Paycom, completing timesheets), leave, and resignations.
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Experience in other provider related healthcare departments such as credentialing, provider relations or contracting preferred. Two (2) Years Experience In Provider Services Required.
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Preferred: PALS, CPR Instructor, refined public relations, verbal and writing expertise. Required: ACLS (within 3 months), BLS (AHA Healthcare Provider), PALS if supervise pediatric department.
$87,261 - $107,798 a yearFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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In these cases, the Labor and Employee Relations Manager will consult with or serve as an active intermediary between the Provider and subject-matter experts in PAGNY Corporate HR or Corporate Payroll on the Provider’s behalf to answer more in-depth questions.
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Bachelors degree, preferably in health care administration, and a minimum of 5 years experience in healthcare, plan or provider operations/administration/ relations or related area. Ensure timely responses to regulatory agencies (i.e., NYSDOH, DFS) in response to all Provider Network regulatory and compliance issues.
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Work Experience: At least 7 years in healthcare and 3 years in provider contracting, provider relations, or provider network operations required. Manage provider relations activities including workshops, provider transactional support, responsiveness to provider inquiries, strategic activity deployment, including EHR access, 5-star enhancements, clinical enhancement deployment (MyCare visits), medical record access, transactional efficiency, provider communications, policy deployment, Provider Manual activities, and other activities of key strategic importance between PacificSource and its external provider network.
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The Director (Provider), in coordination with the Director of Government Relations (Health Plan), will be tasked with ensuring that the interests of the System are being monitored at the local, state, and federal level while also understanding the unique market vulnerabilities and opportunities of the System's hospitals, ambulatory and outpatient facilities, physicians and advanced practice provider groups, and health plan – Priority Health.
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Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters.
$25.44 - $45.76 an hourFull-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters). Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.
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High School Diploma or GED and 7-10 years of experience in contract management, provider relations or provider enrollment in lieu of bachelor's degree. 7-9 years in provider relations, payor contracting, provider enrollment, payor configuration or provider-facility credentialing Required.
$65,190 - $97,785Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Identify the managed care operations you have managed in a Knox Keene licensed health plan and the associated regulatory requirements, as applicable (i.e., Contracting, (Ancillary, Facility, Fee-for-service, Professional, Risk Based), Contract and Benefits Configuration, Compliance, Disputes and Grievances, Credentialing, Claims, Provider Data Management, Provider Relations, Service Operations, or Provider Services.
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