Senior Provider Relations Representative

ProfessionalPosition Purpose: Under direction, the Senior Provider Relations Representative maintains working relationships with provider organizations as assigned. This position is responsible for assuring accurate provider data, monitoring accounts receivable, and providing training, education, and information to providers. Acts as the Company liaison to providers, communicating Health Net’s policies and procedures. May provide guidance or expertise to less experienced associates. Assesses provider-training needs. Assures compliance with contracts.

Assures compliance with respective contracts. Researches, analyzes and resolves claims, benefits, issues and authorization inquiries within delegated authority.

Interprets Health Net’s policies and procedures. Provides interpretation and clarification of benefits, eligibility, and access to care requirements. Escalates recurring or critical issues as appropriate to management.

Assesses provider-training needs. Develops, implements, and conducts appropriate training programs and/or orientations for assigned provider staff.

Monitors provider database of current data relating to provider and physician information.

Ensures provider directories are accurate.

Investigates compliance issues, identifies root cause, trains provider office staff on correct procedures, and provides written report of findings and recommendations.

Meets on a regular basis in person or by telephone with assigned key provider groups to cultivate and strengthen relationships. Documents office visits and provider issues on shared drive log.

Supports the retention of providers by participating in meetings, conducting research, and supporting provider credentialing.

Assists management in tracking, trending and reporting on provider recruitment and retention.

Provides support on special projects and performs other duties as needed or assigned.

Education/Experience: Bachelor’s Degree in Health Care Administration or related field preferred. Minimum three years experience in provider relations, provider contracting; health plan operations or health care/medical office environmentCentene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.TITLE: Senior Provider Relations RepresentativeLOCATION: San Rafael, CaliforniaREQNUMBER: 1155674COMPANY: Network Development & ContractingPOSITION TYPE: Professional