Provider Relations Specialist
Company: HealthTexas
Location: San Antonio
Posted on: May 4, 2024
Job Description:
The Provider Relations Specialist for the continued development,
implementation, compliance management of a cost-effective provider
network, and support the day to day operational needs. This role
will assist in the development of network-wide strategies to
improve efficiencies and access. Under the direction of the
Contract Manager, s/he performs all critical functions necessary to
assess, develop, maintain, and/or improve provider network adequacy
and performance.
In addition, you will be responsible for contributing to the growth
and success of HealthTexas while upholding our Mission, Vision and
Values.
Culture and Values Expectations
At HealthTexas, we believe that our workplace culture is the
cornerstone of our success. We are committed to fostering an
inclusive, collaborative, and innovative environment where every
Associate feels valued, empowered and motivated to reach their full
potential. Our culture is the driving force behind our mission "to
deliver quality and compassionate care with outstanding service,
every patient, every time". As a Provider Relations Specialist at
HealthTexas we expect you to embody and promote our Values and
defined behavioral expectations.
- Integrity: Do the right thing, the right way, every time.
- Be honest and uphold commitments and responsibilities, earn the
trust and respect of the team and those we serve, and maintain
privacy and confidentiality.
- Compassion: Treat everyone with respect and dignity.
- Foster an environment of inclusivity and well-being, practice
patience and empathy, and assume positive intent.
- Synergy: Collaborate to improve outcomes.
- Invite and explore new opportunities, promote effective
communication and teamwork, take pride in yourself, your work and
HealthTexas.
- Stewardship: Use resources responsibly and efficiently.
- Implement effective strategies to attain goals, achieve maximum
productivity and results, and seek continuous knowledge and
improvement.
Essential Job Duties & Responsibilities
- Provides support to the Strategic Development and Managed Care
department for both value based programs and FFS contracts
- Performs both internal and external outreach, monitoring, and
resolution of operational and/or contractual provider related
issues
- Educates provider's staff and providers on policies and managed
care/medical group expectations
- Identifies network gaps and performs recruitment to address
adequacy needs within the network
- Will help execute, maintain, and review Value Based,
Capitation, and FFS contracts
- Be familiar with and have the ability to interpret policy and
procedures to the relation of various healthcare contracts
- Coordinates the management of internal HealthTexas systems to
ensure the accuracy of the provider network.
- Ability to manage and track projects and communicate the
progress of the projects to senior leadership
- Participate in audits and readiness assessments for contract
compliance
- Exhibits understanding and sets priorities to handle multiple
tasks simultaneously, and designs work plans to track progress,
resolve issues, and efficiently and effectively see tasks to
completion
- Investigate and respond to complex provider related issues and
initiate change of provider related database information
- Serve as a subject matter expert for provider relations
activities
- Participate in audits and readiness assessments for delegation
compliance
- Assists with In Network provider inquires and provider/group
demographic changes within HealthTexas' claims and electronic
medical record systems
Experience
- 2+ years of experience with provider service/provider relations
operations/managed care, or relevant experience preferred
- Knowledge of Federal and State law, NCQA, Medicare, Medicaid,
and relevant guidelines, regulations and standards; i.e., claims
processing, UM programs, provider contract administration, , HEDIS,
CMS STARS, etc.
- Effective communication (both verbal and written) and
relationship building skills
- Team-player, innovative, problem solver,
- Possesses experience in and a working knowledge of managed care
plans and programs
- Must be detail-oriented, well organized, have the ability to
multi-task effectively, manage time and meet deadlines
- Expertise in Microsoft Office programs and industry-standard
applications as appropriate
Education
- High school diploma or equivalent.
- Preferred Bachelor's degree in Business Administration, Health
Care Administration or other related field
Knowledge, Skills & Abilities
- Demonstrates commitment to high professional ethical
standards.
- Ability to adapt to a fast paced, continually changing business
and work environment while managing multiple priorities.
- Knowledge of health care, managed care, Medicare and
Medicaid.
- Strong technical, analytical, and trouble-shooting
skills.
- Excellent follow-through skills; self-motivated and
detail-oriented.
- Strong organizational skills to manage multiple projects,
issues, and priorities effectively and simultaneously, with
attention to detail.
- Highly analytical and detail oriented with strong interpersonal
written and oral communication skills.
- Expertise in Microsoft Office programs and industry-standard
financial applications as appropriate
Work Hours, Travel Requirements
- Monday - Friday, 8:00 a.m. - 5:00 p.m., and as needed to
complete projects.
- Travel to medical offices may be necessary for the purpose of
providing benefit education.
Working Conditions & Physical Requirements
- This job operates in an office setting. This role routinely
uses standard office equipment such as computers, phones,
photocopiers, scanners, filing cabinets and fax machines.
- The physical demands described here are representative of those
that must be met by an employee to successfully perform the
essential functions of this job. While performing the duties of
this job, the employee is regularly required to talk and hear. This
is largely a sedentary role; however, some filing is required. This
would require the ability to lift files, open filing cabinets and
bend or stand on a stool as necessary. Specific vision abilities
required by this job include close vision, distance vision, color
vision, peripheral vision, depth perception and ability to adjust
focus.
PM22
PI5f84858b195b-31181-34214501
Keywords: HealthTexas, San Antonio , Provider Relations Specialist, Other , San Antonio, Texas
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