At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
Serves new network providers ensuring a smooth entry in to network participation. Responsible for directly contracting and supporting network providers and their office staff with the ultimate goal of maximizing in-network knowledge, participation, and satisfaction for providers. Activities include: provider recruitment, provider education, screening for network participation requirements, and educating providers on network plan protocols. Also responsible for identifying, tracking, and communicating provider issues and determining root cause and resolution approaches in consultation with the Network Support Coordinator.
Job Description
Minimum Qualifications
Education: Bachelor's degree is preferred; In lieu of a bachelor's degree, four (4) years of industry experience; in provider relations, claims operations, insurance or managed care environments preferred
Licenses/Certifications: (None)
Experience / Knowledge / Skills:
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With degree one (1) year of relevant experience
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Without degree four (4) years of relevant experience
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Knowledge of managed care and risk contracting, claims resolution, and changes in the healthcare environment
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Knowledge of Accountable Care Organizations (ACO), Clinical Integration (CI), and Patient Centered Medical Home (PCMH) environments is a plus
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Data entry and customer service experience is preferred
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Strong communication skills for provider audiences
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Strong interpersonal skills to effectively interact and build strong relationships with stakeholders
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Excellent organizational and prioritization skills
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Strong critical thinking and analytical skills to identify customer needs and develop action plans
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Working knowledge of MS Office Products including: Excel, Word, and PowerPoint. Knowledge of MS Access is a plus
Principal Accountabilities
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Answers provider relations community phone line; triages, logs, and directs calls as appropriate.
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Facilitates the process of onboarding new providers, including educating the provider on the process and membership expectations, obtaining required documents, and coordinating membership approval through the required parties.
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Educates providers and office staff on network membership benefits, participation in contracted health plans, and health plan protocols.
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Provides customer service to providers including insurance claim review, basic fee schedule analysis, and contract compliance. Acts as a liaison between the provider and contracted health plans to facilitate reimbursement according to contracts.
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Provides demographic/informational updates to stakeholders on a weekly basis to assure database accuracy, including current provider practice information.
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Provides network support to the network Practice Consultant team.
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Promotes participation and compliance with the ACO, CI, and PCMH programs.
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Serves as a resource to identify barriers to participation; facilitates with provider/service line liaisons to encourage in-network participation; monitors and communicates trends
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Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
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Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
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Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
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Other duties as assigned.