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Provider Relations Specialist I
Job Title: Provider Relations Specialist I
Job Type: Full-Time
Location: Columbus, OH
Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices.
High school diploma or equivalent. 3+ years of sales, provider relations, or contracting experience. Knowledge of health care, managed care, Medicare or Medicaid. Bachelor’s degree in healthcare related field preferred. Claims billing/coding knowledge preferred.
Licenses/Certifications: Current state driver’s license.
• Serve as primary contact for providers serving as a liaison between the provider and the health plan
• Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site and routing to the appropriate party for resolution
• Receive and respond to external provider related issues
• Initiate entry or change of provider related database information and oversee testing and completion of change request
• Investigate, resolve and communicate provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving
• Perform provider orientations, including writing and updating orientation materials
• Ability to travel