Provider Relations Analyst

This position serves as an integral member of the Nonpar Provider Contracting Team and reports to the AVP, National Contracting & Nonpar Network Management.

Supporting our evolved enterprise strategy, this role is one of the primary department contact(s) for non-par single case agreements.

Summary : Primarily responsible for the department's Daily Trucare report case assignment, claims review and adjustment reporting assistance, and back-up to the department's Intake email and voicemail box, on an as needed basis.

Provides high quality service to internal and external partners.

Specific responsibilities include, but are not limited to: ability to partner with various groups in resolving complaints and disputes, and ensures compliance with policies and procedures.

Assists providers with inquiries into the boxes, on an as needed basis.

Facilitates and manages daily TruCare Report and negotiation assignment.

Co-manages claims review and adjustments as directed by Provider Relations Sr.

Auditor & Analysis Manager.

Proven communication skills.

Ability to move quickly and navigate a high paced environment.

Highly proficient with balancing multiple priorities.

DUTIES AND RESPONSIBILITIES


* Complete daily TruCare report.


* Review and prioritize daily work assignments to the department Provider Network Managers for timely single case agreement negotiation.


* Assist providers with inquiries (email and voicemail), on an as needed basis.


* Single Case Agreement Claims review and adjustment reconciliation.


* Familiarity with Oneview, FACETS, PMHS, ProClaim.


* Supports department-based goals which contribute to the success of the organization.


* Communicate, collaborate, and cooperate with internal and external business partners.


* Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations.


* Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.

POSITION REQUIREMENTS


* Healthcare claims, customer/provider relations experience, required.


* Bachelor's degree, preferably in the areas of Finance, Healthcare or Business.


* Team subject matter expert (SME) for all Claims platforms and processing procedures.


* Familiarity with key concepts around the prior authorization process, in-network versus out of network providers, medical service components (i.e.

procedure/service codes, modifiers).


* Strong experience in Trucare, ProviderLink, OneView, ICMS, ProClaim, FACETS, and PMHS.


* Proficient in Microsoft Office Tools (Outlook, Access, Excel, Word, Powerpoint, Sharepoint).


* Supports department-based goals which contribute to the success of the organization.


* Communicate, collaborate, and cooperates with internal and external business partners


* Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations.


* Fosters an en...