Centers Plan for Healthy Living

Provider Services Representative

Job Locations US-NY-Garden City
Posted Date 2 weeks ago(2/6/2018 2:12 PM)
ID
2018-1267
Category
Provider Services

Overview

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Join the excitement in support of our MLTC and Medicare Advantage Plan businesses!

 

Centers Plan for Healthy Living (CPHL), is a Managed Care Organization servicing members with Medicare and/or Medicaid.  Our goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living. CPHL is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community.

 

Job Summary:

 

The Provider Relations Representative assures that all provider orientations, site visits, access and availability studies are completed within established timeframes. This position establishes and fosters strong positive relationships with key providers by coordinating and facilitating meetings and identifying onsite enrollment opportunities.

Responsibilities

  • Establish and foster strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying onsite enrollment opportunities for Marketing.
  • Proactively identify provider needs and advise management so that action can be taken to address the needs before they are problematic for the provider.
  • Assure that all provider orientations, site visits, access & availability studies are completed within designated timeframes.
  • Educate providers on the CPHL product lines and benefit programs.
  • Facilitate member healthcare records to ensure achievement of optimum HEDIS scores.
  • Assist Network Contracting in identification of network deficiencies and make recommendations on how to address them.
  • Conduct Access & Availability studies as needed. Conduct Delegated Credentialing audits and on-site provider office assessments required for credentialing.
  • Investigate and resolve complaints regarding providers to maintain member and provider satisfaction. Clarify the provider's problem; determine the cause of the problem; select and explain the best solution to solve the problem and expedite correction or adjustment; follow up to ensure resolution.

Qualifications

Education:

  • Required:   AA degree
  • Preferred:   BS/BA degree

Type of Experience:

 

Required: 1 –3 years working in a managed care environment serving in a provider relations, contract management or equivalent role.    

 

Certifications/Licensure:

 

Required:    Current/Valid Driver’s License

           

Knowledge and Skills:

  1. Knowledge of various provider payment methodologies.
  2. Experience with PC based applications.
  3. Strong verbal and written communication skills

Physical Requirements:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Must be able to travel within service area.
  • Must be able to drive.

The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.

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