Provider Relations Liaison
Phoenix AZ 85034
Job DescriptionKey contributor to the development and management of contracted providers, which include contracting with hospitals, ancillary providers, medical and behavioral health practitioners throughout and assigned geographic region. Duties can include sourcing providers for outreach phone calls, on-site travel, contract development, negotiation of language and rate methodology within prescribed parameters.
Responsible for interacting with providers to initiate and manage the credentialing and re-credentialing process as may be required.
Manages the relationships with key health plans and provider networks for the purpose of implementing the company`s cost saving products into large markets nationally. Works daily to improve the relationships with health plan partners and resolves any outstanding issues that may develop. Increases the product for each health plan partner, and seeks medical cost saving programs for all members in the market. Enhances any process or procedure to best serve the Provider Network, and allows our program to be successful. Reports any high level issues for timely resolution and satisfaction.
- Assumes role in researching provider complaints and issues, collaborates with staff from various internal operations areas to determine root causes. Remedies problems, being on point to communicate with providers throughout the course of problem resolution.
- Takes the front-line in establishing and maintaining strong communications with providers.
- Develops and maintains strategic and tactical approaches to relating to high-impact providers in the network that will distinguish the company in the industry and result in peak provider satisfaction and network stability.
- Establishes and maintains optimal communication channels with client provider relations and account management to foster confidence in the company`s abilities to rapidly resolve provider issues.
- Identifies opportunities for promoting broader use of web services and proactively communicates with providers not taking full advantage of these services to understand why.
- Identifies providers not availing themselves of EDI and EFT, and proactively communicates with them to transition them to these platforms.
- Conducts telephonic, web-based and onsite training sessions (individual and group) for new network participants (rendering providers) and for ordering providers during new client implementation phases.
- Conducts training sessions for clients? provider relations and call center staff so as to equip them with the background knowledge of processes to assist in their ongoing training of their network providers.
- Routinely monitors provider performance to target and perform remedial training sessions based upon area of need (e.g., authorization processes, claims submissions, etc.)
General Job Information
TitleProvider Relations Liaison
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date11/20/2018
Date Requisition Created11/20/2018
License and Certifications - RequiredAHIP - Americas Health Insurance Plans - Enterprise, NYHIL - New York Health Insurance License - Enterprise
License and Certifications - Preferred
Other Job Requirements
Responsibilities3+ years experience as hospital or physician liaison or pharmaceutical representative.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled