Provider Relations Specialist I
Job Title: Provider Relations Specialist I
Job Type: Full-Time
Location: Columbus, OH
Job Description:
Position Purpose:
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.
Knowledge/Experience:
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.
Position Responsibilities:
• 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
