Provider Relations Representative – Remote Position

Community Health Options Remote
provider relations relations representative remote health providers provider relations relations materials managed care ancillary procedures operations
March 12, 2023
Community Health Options
Nashville, Tennessee
Join our team text PROVIDER to 207-367-3977 to apply!
Position Summary
Community Health Options (Health Options) Provider Relations Representatives are responsible for educating and supporting the existing provider network by establishing and maintaining positive, professional relationships with participating providers; designing, distributing and/or presenting educational materials; assisting with and responding to provider inquiries; monitoring compliance and issue resolution within the managed care regulatory environment. The role also will support process improvement efforts to proactively service provider inquiries and issues.
Key Responsibilities
  • Build positive, professional relationships with assigned participating providers and administrative staff.
  • Maintain a credible presence throughout an assigned area making frequent provider contacts in an effort to support network retention.
  • Utilize working knowledge of provider contracts, physician/hospital/ancillary reimbursement methodologies, and product line benefit documents to deliver service excellence to all stakeholders.
  • Design, distribute and/or present orientation materials to identified audiences within a hospital, ancillary, or physician office.
  • Coordinate large scale on-site educational meetings.
  • Review, maintain, and communicate policy updates, procedures, and benefit information to providers.
  • Participate in the development and maintenance of departmental policies, procedures.
and performance standards used for coordination of daily Provider and Network Operations activities.
  • Assist with provider recruitment/contracting and provider network retention negotiations to ensure adequate provider resource availability for Health Options Members.
  • Gather competitive and industry information that includes, but is not limited to, current reimbursement methodologies, service-related offerings, and financial profiles.
  • Maintain provider database to accurately record and update provider demographic and contract information in support of Health Options operations and achievement of strategic goals.
Key Competencies
People within Health Options are expected to work with integrity, humility, strategic vision, curiosity, and discipline. They must be self-motivated, highly effective, and compassionate communicators, effectively leading people, work processes, and actively engaging in continuous process improvement.
Health Options diversity initiatives are applicable—but not limited to—our practices and policies on recruitment and selection; compensation and benefits; professional development and education; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of diversity equity, which encourages and enforces
  • Respectful communication and cooperation between all employees.
  • Teamwork and employee participation, permitting the representation of all groups and employee perspectives.
  • Work/life balance through flexible work schedules to accommodate employees’ varying needs.
  • Employer and employee contributions to the communities we serve to promote a greater understanding and respect for the diversity.
  • Associates degree or 2+ years of experience in a related managed care or healthcare role.
  • Demonstrated ability to succeed in a fast-paced collaborative environment.
  • Stellar communication and relationship building skills.
  • Detailed oriented, a bias towards action, and impeccable follow-up skills.
  • Proven ability to manage multiple tasks and initiatives.
  • Exceptional organization skills.
  • Friendly, service-focused, helpful approach and attitude; exercises and displays patience and professionalism during stressful situations.
  • Other related experience may be considered in lieu of the stated requirements.
REMOTE WORKERS: This is a full-time remote position that will require the Provider Relations Representative to provide sufficient Internet bandwidth to meet system operational needs, and to have a home office environment that protects the privacy and integrity of confidential information.

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