Provider Account Specialist - SHP Health Services - Sharp Tech Way - Day Shift - Full Time

Hours:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

Not Specified

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$33.090 - $42.700 - $52.310

 

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 

 

What You Will Do
Serves as the primary liaison between providers and the Plan, by establishing and maintaining positive working relationships through provider engagement and management. Develops and presents provider orientation/training and other resources to educate providers and key provider staff on Plan products, processes, and contract terms, both orally and in writing. Resolves provider inquiries and complaints in a timely manner using data analysis, critical thinking and dispute resolution techniques. Maintains continual contact with Plan providers and tracks provider interactions for reporting, trend analysis and follow-up purposes.

Required Qualifications

• Bachelor's Degree in Healthcare Management, Business, or other degree acceptable with combination of education and managed care experience.
• 3 Years experience in a managed care or healthcare environment interfacing with medical providers.
• Driver's License - CA Department of Motor Vehicles -REQUIRED

Preferred Qualifications

• Coursework in medical terminology and/or medical billing.
• Experience in sales and marketing with customer relationship responsibilities.

Essential Functions

• Provider Relations
  Maintains close contact with Plan providers to stay up-to-date on their provider activities, program and initiatives for the Plan, including personal visits, written correspondence and phone contact.
  Drives operational efficiencies by resolving provider inquiries in a prompt and timely manner.
  Effectively conducts issue management and resolution using diplomacy and dispute resolution techniques.
  Leads customer relationship engagement activities such as education and committee initiatives.
  Employs focused and organized relationship management approaches to build and maintain strong relationships with Plan providers, and ensures that a high level of service and interaction is provided, including accurate and timely claims processing, issue resolution, performance recognition, education and training programs, and organizational support.
  Interacts effectively and professionally at different levels within and outside the organization for the purpose of developing and enhancing provider relationships.
  Maintains the provider operations manual, and provider communications to ensure compliance with regulations and contract requirements.
  Coordinates plan medical group and provider transitions and rollouts, including the facilitation of transition team meetings, and assistance with development of internal and external communications.
  Develops localized market expertise, including market issues, provider reputations, provider strengths and weaknesses, provider quality, availability, and referral source patterns, by establishing a personal presence in the market.
  Develops and executes action plans for the implementation of projects and provider communications, as needed.
  Recommends and/or drafts provider communications relative to health plan policies and procedures.
  Develops a communication plan for distribution of Plan policy changes and ensures that inventory of provider communication materials is maintained and tracked.
  Maintains a visitation and contact log to ensure thorough documentation of communication and follow-up.
  Ensures that contract is understood by the provider and that the provider is in compliance with contract.
• Training and Education
  Educates Plan providers on Plan policies, procedures, contract terms, programs and initiatives through continual communications.
  Develops and implements an Orientation Program for all new providers who meet the credentialing requirements and who are recommended for acceptance by the Network/UM/Contracting Committee. The orientation should include a complete education regarding a) Plan policies and procedures including authorizations and referrals, cla