Provider Relations Specialist: BMC HealthNet Plan

Key Functions & Responsibilities:

• Participates in the assembly, maintenance and preparation of materials for Provider orientations, site visits and recruitment in addition to letter of interest process. 
• Takes minutes for key Provider site visits and JOC meetings, and distributes minutes to meeting participants. 
• Assists in the scheduling of Provider Relations trainings and servicing meetings.
• Researches and facilitates interdepartmental issues related to reimbursement, claims, credentialing, and other network issues as identified by the External Provider Account Representatives.
• Acts as liaison for reimbursement, credentialing, claims, EDI website procedures and issues of key providers. 
• Facilitates resolution of complex member/provider issues and collaborates with internal departments related to resolution.
• Collects and tracks Provider data, oversees compilation and maintenance of pertinent database information in Quickbase and Onyx.
• Conducts credentialing site visits as needed. Provides coverage for Proivder Relations Representatives in their absence.
• Processes activation/change forms and spreadsheets as needed Responsible for gathering and submitting data on non-par providers. Assists in creation and distribution of provider web logins
• Manages distribution and research of returned mail. Manages the distribution and resolution of CRU tickets and claims workflow.
• Assists in ensuring completeness of information needed to complete contracting and credentialing processes. Manages creation and distribution of welcome letters and low priority recruitment mailings.

Education & Experience:

• High School Diploma or GED required. Associates degree in Business Administration or related field strongly preferred.
• 2+ years business experience in a business or healthcare setting is required.

Competencies, Skills, & Attributes:

• Demonstrated competence using Microsoft Office products especially Word, Excel, Outlook, Access, PowerPoint.  Experience or knowledge of FACETS or similar claims processing system. 
• Effective communication skills (verbal and written).
• Ability to work as a team member.  Must be able to manage multiple tasks and possess excellent organizational skills.  Ability to be flexible and work independently. 

Travel:

• Up to 25% local travel.
• Must have valid drivers license and access to a car.