GENERAL SUMMARY
Responsible for maintaining working relationships with the existing provider network. Assists providers with policy and procedure interpretation. Maintains accurate and current databases relating to provider facilities and physician information. Assists with physician recruitment.
ESSENTIAL RESPONSIBILITIES
- Maintains regular contact with key provider organizations and serves as a liaison to internally resolve complex issues. Develops strong interpersonal relationships with assigned providers.
- Researches and resolves incoming escalated provider inquiries within contract guidelines. Educates providers on new protocols, policies, and procedures.
- Assists with physician recruitment by identifying specific providers within a designated territory, facilitating the distribution of provider agreements, negotiating rates for new physicians, and renegotiating contracts for existing physicians within established limits.
- May conduct provider office site visits to ensure site meets contract guidelines.
- Provides assistance to less experienced Provider Relations Representatives to help resolve complex provider issues. Serves as subject matter expert to other department staff.
- Ensures provider database and documentation is up-to-date, accurate, and complete. Ensures new physician contracts are entered promptly and accurately.
- Assists with the development and implementation of provider training programs.
- Serves as a training resource and mentor to Provider Relations Representatives. Identifies and shares best practices.
- Analyzes changing business requirements; makes recommendations to management for process improvements as required.
- Performs other duties as required.
Qualifications:
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Atlanta, GA, US
Organization: 20000 - CHC of Georgia
Schedule: Full-time
Job Posting: 2013-01-25 00:00:00.0
Job ID: 1310160