Provides day to day relationship management with the Health Plan partners and providers. Responds to inquiries, solving non-routine problems, and ensuring partner and/or provider satisfaction. Provides support and acts as a technical resource regarding policies, procedures, workflows, complex partner and provider issues and training needs. Supports the promotion of the programs being implemented; program enhancements; partner and provider engagement on a regular basis, both in person, over the phone and email, to understand concerns and service requirements; advocates for partner needs. Provides support by educating, designing, distributing and/or presenting educational materials; assisting with policy and procedure interpretation and monitoring compliance and issue resolution.
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Supports all lines of business with the Health Plan.
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Provides support for provider contracts; physician, hospital, ancillary reimbursement methodologies; product line benefit documents; quality initiatives; and departments within the Health Plan.
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Collaborates internally with departments to align strategic relationships.
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Participates in development activities throughout both new and existing markets, including tracking and reporting of recruitment activities, progress and barriers to a successful launch.
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Assists with provider recruitment and contracting and provider retention negotiations to ensure adequate provider resources for Health Plan's provider network.
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Gathers competitive information, current reimbursement methodologies, service related offerings and financial profile.
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Reviews and develops ways to streamline and simplify internal processes as necessary to reduce turnaround time and improve data quality.
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Initiates process improvement projects resulting from operational concerns.
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Manages ongoing account activity and serves as the liaison between the provider or partner and the Health Plan.
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Coordinates and communicates contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements and relationships.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).
Internet requirements:
Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is:
- 25 MBPS UP
- 75 MBPS DOWN
- <150 ms Ping Required
- <30ms Jitter Required
Computer must be connected to the internet via Ethernet cable; wifi is not permitted unless a Virtual Private Network (VPN) is used for the wifi connection
High School Diploma or Equivalent (GED)- (Required)
Minimum of 8 years-Relevant experience* (Required)
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.