Provider Relations Representative- Health Plan

Location: Mockingbird Towers 4th FLR

PCHP- Parkland Community Health Plan

Primary Purpose

The purpose of this position is to provide exceptional business service to our network of participating providers by serving as the primary liaison between providers and the health plan as well as identifying new providers to complement and expand the network. The Provider Business Consultant will execute onboarding, education, and outreach activities to ensure provider adoption, adherence and compliance with Parkland Community Health Plan (PCHP) quality management and accountable value based care programs. The Provider Business Consultant will continuously execute PCHP's network development plan to ensure best-in-class performance toward improving our quality of care, improving our patient experience, and reducing avoidable costs.

Minimum Specifications

Education

• High school diploma or equivalent
• Bachelor's Degree in healthcare related field preferred.

Experience

• 4 years of provider support, education, relationship management or contracting experience is required.
• 3 years of claims, billing, coding or revenue cycle management experience is required.
• Three (3) years of direct healthcare fee schedule and/or charge master maintenance experience is preferred.
• Three (3) years of claims/billing systems maintenance and configuration is preferred.

Equivalent Education and/or Experience

• Additional education can substitute for experience requirements.

Skills or Special Abilities

• Advanced knowledge of health care including managed care programs that administer Medicare and/or Medicaid.
• Advanced level knowledge of provider reimbursement methodologies.
• Advanced level knowledge of network development strategies, clinical integration and accountable value based care principles.
• Expertise in gaining consensus and negotiating performance improvement plans.
• Effective knowledge of the Texas Department of Insurance, the Office of the Inspector - - - General and other state agencies involving claims and Fraud, Waste and Abuse programs. Functional knowledge of Current Procedural Codes (CPT), ICD-10, CMS 1500 professional claims, UB ancillary, and hospital clean claim guidelines.
• Ability to utilize personal computer applications.
• Advanced level written and oral communication skills.

Requisition ID: 986737