PROVIDER RELATIONS REPRESENTATIVE

Job Summary

The Provider Relations Representative supports, develops and maintains service relationships with contracted and non-contracted providers. contracted or non-contracted such as (primary care and specialty physicians, skilled nursing facility, and durable medical equipment providers) of a provider network. Responds to inquiries from health care providers regarding a variety of topics, i.e., policy changes, universal enrollment, provider portal, bulletins, etc. Works on projects/matters of limited complexity in a support role. Work is closely managed.

Typical Duties

• Responsible for the day-to-day interaction with contracted and non-contracted providers of the health plan.
• Accountable for the daily maintenance of provider relationships with all contracted PCP, PCP group, specialist and specialty group providers, hospital, skilled nursing, ancillary, allied health, dental, vision and other contracted groups of health plan.
• Develops relationships with non-contracted entities serving health plan members explaining limitations and policies around serving enrolled members of health plan.
• Arranges for the capture and distribution of monthly/quarterly provider data submission for contracted entities of health plan.
• Responsible for educating new and current providers on health plan policies including provider manual, quick reference guides, provider directory accuracy and payment policy updates
• Responsible for reviewing and suggesting updates of all public/website information for providers monthly to ensure health plan is compliant with regulatory policies.
• Works with provider data management to ensure provider data information is properly loaded and codified.
• Organizes reports on provider cost and outcome data at joint operating committee meetings with specific designated providers.
• Provides assistance to contracting team in identification of new providers for participation in health plan network.
• Coordinates with third party administrators, If applicable.
• Identifies and recommends appropriate changes in operating procedures and systems that might be required to accommodate provider contracts.
• Captures and sends quarterly management reports to assigned participating groups allowing them to manage their success within the Cook County Health (CCH) provider network.
• This position may require some travel within CCH service area.
• Performs other duties as assigned.

Knowledge, Skills, Abilities and Other Characteristics

• Strong problem-solving skills used to anticipate and identify issues and to develop and implement appropriate solutions related to complex administrative processes.
• Strong interpersonal skills are critical as this position works closely with health plan network provider, and internal members of the managed care leadership team, and other members of CCH leadership.
• Strong verbal and written communication skills as this position will frequently present data, trends, and performance results to members of upper management and CCH leadership.

• Meet the minimum qualifications for the position.
• Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, “Are you a Military Veteran?”
• Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable

• A copy of a valid State ID Card or Driver’s License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.

BENEFITS PACKAGE

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan
• Deferred Compensation Program
• Paid Holidays, Vacation, and Sick Time
• You may also qualify for the Public Service Loan Forgiveness Program (PSLF)

For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/

• 
  Degrees awarded outside of the United States with the exception of those awarded in one of the United States’ territories and Canada must be credentialed by an approved U. S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents bust be presented at time of interview.

• 
  Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.

• 
  CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.