Provider Relations Representative |
| Oct. 21, 2009 - Oct. 21, 2010 |
| Location: | St. Petersburg, FL |
| Employment Type: | Full Time |
| Department: | Provider Operations |
| Description: | This position is responsible for both the negotiation of physician/provider contracts as well as ongoing education/service to the physician/provider network in assigned market areas. |
| Duties: | Conduct a quarterly audit to identify network gaps, determine ongoing network needs, and provide written provider goals.
Identify, on a semi-annual basis, opportunities for re-negotiation of contracts by line of business and provider category.
Negotiate rates that will achieve goals for Medical Loss Ratios (MLR).
Act as liaison with physician/providers to facilitate open communication, excellence in service and provide assistance where needed.
Notify Supervisor of trends and problematic areas within networks applying problem solving skills and offering solutions to issues.
Maintain network stability as it relates to physician/provider terminations and panel closing by primary care physicians.
Implement, throughout service visits, electronically, and telephonically, educational tools for physician/providers and their proactive staff.
Maintain reporting requirements for provider data
Maintenance of assigned Provider contract files.
Work closely, in assigned markets, with the Marketing and Sales team and primary care physician practices to achieve/exceed membership growth projections.
Conduct quarterly outreach calls to primary care physician offices and high-volume specialists.
Conduct yearly visits to primary care physicians, specialists and ancillary providers.
Manage provider demographic information changes and resolve identified problems.
In conjunctions with the department manager, develop and implement strategies for reduction of Medical Loss Ratios (MLR) in identified primary care physician practices.
Abide by all compliance requirements to the Department of Insurance (DOI), Agency for Health Care Administration (AHCA) and the Centers for Medicare and Medicaid Services (CMS) as these apply to Provider Relations Department activities.
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| Qualifications: | Bachelor's Degree or equivalent combination of education and related experience, required.
3-5 years experience in managed care setting, health plan or large medical group administration, preferred.
Valid Driver's License, reliable automobile and current insurance.
Exceptional customer service skills, ability to conduct presentations, and strong public speaking skills.
Highly self motivated, able to establish support and interact well with physicians and individuals on all levels.
Ability to positively motivate and influence others.
Ability to effectively multi-task and manage a variety of complex issues.
Ability and willingness to travel.
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