Provider Relations Specialist

Responsibilities

• Supports enrollment and data submission efforts related to provider contracting and network participation.
• Receives inquiries from providers and HWMG employees via email, telephone and fax. Replies to emails to confirm receipt.
• Analyzes incoming requests to determine the appropriate Provider Relations (PR) team member to which to assign and responsible for provider maintenance and contracting tasks based on the nature of these requests.
• Provides initial direction to providers who are seeking to join the HWMG network.
• Coordinates the execution of certain provider agreements in preparation for network enrollment.
• Identifies providers who are terminating from a line of business (such as consulting) or from the HWMG network.
• Supports assigned reporting requirements, ensuring timely submission of requested data and documentation.
• May assist in producing or providing data for weekly status reports for management review.
• Locates or provides copies of contracting files, fee schedules, and related documents during audits and as necessary to complete research or respond to an inquiry.
• Generates provider online registration and forgotten password communication as needed.
• Ensures processed contracting files, applications, provider correspondence, and related documents are properly prepared for scanning in internal systems.
• Manage all incoming and escalated calls to the department’s ACD phone line. Triage calls that need escalation to the Provider Relations Specialist or other team members and document hand off.
• Logs provider complaints, appeals, inquiries, and outcomes.
• Assists with department projects.
• Performs administrative functions to ensure participating providers are credentialed in a timely manner and monitored on an ongoing basis. This includes, but is not limited to, data entry, file audits, requesting information, sanctions monitoring, and maintenance of electronic files.

Qualifications

• Excellent customer service, organizational, time management and verbal and written communication skills.
• Strong attention to accuracy and detail.
• Able to multi-task and work independently and in a team environment.
• Read and interpret forms and documents such as applications and procedure manuals; and write correspondence
• Maintain professionalism in stressful situations
• Intermediate-level proficiency in Microsoft Word and Excel
• Solve practical problems and interpret a variety of instructions furnished in written, oral, diagram, or schedule form
• Add, subtract, multiply, divide, and calculate figures and amounts

Screening Criteria

• MUST HAVE STABLE EMPLOYMENT HISTORY.
• 1 year experience in the role or related field