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Provider Relations Specialist II

Tacoma, WA 98402

Post Date: 04/25/18 Job ID: 44548 Industry: Customer Service Representative

This Fortune 500 client is a nation-wide leader in the healthcare services field and they pride themselves on their ability to provide a wide range of government sponsored healthcare programs; including a variety of insurance solutions. Currently, they are seeking a Provider Relations Specialist, to perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as liaison between providers and the health plan to enhance the business relationship.

Position: Direct Hire

Location: Tacoma, WA

Similar positions: HIM Specialist, Provider Specialist, Manage Care Specialist, Clinical Specialist

Responsibilities of the Provider Relations Specialist:
  • Perform provider orientations and educational outreach
  • Resolve provider relation matters and document resolution
  • Act as liason between provider and healthplan
  • Perform Health Benefits Ratio Analysis and HEDIS for provider review
  • Inform providers regarding policies and procedures related to referrals, claims submission, credentialing, EHR, Health Information Exchange and Electronic Data Interface.
  • Perform other contracting duties as assigned.
  • Education/Experience: Bachelor s degree in related field or equivalent experience.
  • 2+ years of combined managed healthcare and provider reimbursement experience.
  • Advanced knowledge of Microsoft Excel.
  • Clinical or health information management (HIM) experience preferred.
  • Claims processing and/or managed care experience preferred.
  • Licenses/Certifications: Current state driver s license.
  • Applicants must be currently authorized to work in the United States on full-time basis

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