Lead Provider Relations Representative

Job ID: J123981
Company: Gateway Health Plan
Location: Home, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: May 31, 2018

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Description

GENERAL PURPOSE:  

The Provider Relations Representative is the primary liaison between the provider network and the Corporation. Maintain a quality network of providers who supply medical and dental care, goods and services to members.  Responsible for recruitment, personal visits, orientation and interactive training.  Apply an active role in network management, training, monitoring and enforcement of company policies and procedures while increasing provider efficiencies.  The lead level will assist the Director with development, administration and communication to include registration of and contracting with providers for the accurate and timely payment of claims to providers and members. 

ESSENTIAL RESPONSIBILITIES:

1.  Conduct on-site visits to provide orientation, continuous training and education to the provider network. Partner with the health care provider network to encourage their support of company initiatives as well as compliance with policies and procedures. 

2. Monitor, analyze and develop strategies for improving network participation and performance.  Recruit additional providers to enhance the company’s ability to promote a network to current and potential customers.  Deliver efficient communications between providers and the corporation, ensuring providers utilize various electronic means of communication.

3. Fulfils a liaison role with Operations and Support areas to ensure the appropriate development and execution of initiatives, communication needs, and issue resolution.

4. Communicates and maintains effective working relationships both internally (team members, management, and other key areas with whom we work closely) and externally (providers, provider associations, vendors) keeping management informed on related healthcare industry issues/topics.

5. May be a team member for corporate projects impacting providers ensuring team and provider communication is appropriate, provider impacts are considered, and appropriate tasks are executed by team members.

6. May provide strategic and operational input for network development and servicing to ensure members have access to quality, cost effective care and that the plan appropriately and timely responds to the customers’ needs and efficient/effective operations of the department are maintained to meet corporate initiatives.

7. Other duties as assigned or requested.

QUALIFICATIONS:

Education, Licenses/Certifications, and Experience 

Minimum

  • HS Diploma or GED
  • 10-15 years of related progress experience in the area of specialization including experience in leading projects of varying size and complexity. Grandfathered experience requirements effective August 2016.
  • Valid Driver License

Preferred

  • Bachelors’ degree
  • 1-3 years of Project Management and/or Business Analyst experience
  • 3 years of management or leadership experience

Knowledge, Skills and Abilities 

  • Strong interpersonal organizational and analytical skills and management skills and the ability to perform under pressure within rigid time constraints, without the loss of efficiency, quality and professionalism as demonstrated by previous positions held.
  • Willingness and agreement to continue educational course work in direct relation to the position and travel for additional training or business purposes as necessary.
  • Demonstrated ability to analyze situations and data to identify issues, determine points of relevance and proper course of actions. 
  • Superior communication (written and oral), teamwork, organizational and leadership skills as demonstrated through previous performance, testing and/or academic background.
  • Ability to identify, establish and meet corporate goals and objectives.

SCOPE OF RESPONSIBILITY 

Does this role supervise/manage other employees?       

No

WORK ENVIRONMENT

Is Travel Required?

Yes   

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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