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