OverviewManages all aspects of provider relations within a specified geographic region. Regularly visits and maintains ongoing contact with existing/potential providers for relationship building, recruitment, credentialing, re-credentialing and assisting with provider issues and education. Works under general supervision. Bilingual Urdu or Bengali required.
Compensation:$30.71 - $38.41 Hourly
What We Provide:
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, including Medical, Dental, Vision, Life, and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, CEU credits, and advancement opportunities
- Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals
What You Will Do:
- Manage all provider contracts in designated territory, including recruitment, credentialing, recredentialing, and relationship maintenance through regular visits and ongoing contact with existing and potential providers.
- Prepare materials for and orient providers to contract terms and operating requirements, Health Plan program and eligibility requirements, and service coordination.
- Collaborate with the Network Development and Contracting and Service Operations departments to administer demographic changes and renewals to provider contracts.
- Monitor contract performance of network providers and serve as a liaison between the Health Plan and the Provider to ensure the flow of information regarding resolution of member service issues.
- Coordinate provider site visits, as needed.
- Coordinate and attend meetings to serve as a resource and address provider issues.
- Update and maintain provider manuals with current Health Plan policies and procedures.
- Update and proof provider directories.
- Assist providers in triaging billing and claims disputes.
- Participate and collaborate with Compliance on Department of Health and internal audits.
- Participate in special projects and perform other duties as assigned.
Qualifications:Licenses and Certifications:Driver's license required.
Education:Bachelor's Degree or equivalent related work experience, preferably in a health care setting required.
Work Experience:Minimum three years health care experience required. Knowledge of government programs, including Medicare and Medicaid preferred. Prior experience in Provider Relations preferred.
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