Provider Consultant
Cherry Hill, NJ Cherry Hill, NJ Full-time Full-time $55,000 - $65,000 a year $55,000 - $65,000 a year This position is responsible for the following:
Serve as the primary liaison between The Healthcare Network and the participating provider community who service our members in multiple product lines throughout New Jersey area - mostly Atlantic & Ocean counties on the East coast of NJ.
Build and maintain strong relationships with providers by offering excellent customer service to assigned primary care, and specialty care physicians with routine and targeted education visits for the purpose of continued education regarding policies/initiatives.
Service also includes supply deliveries and prompt follow up regarding claims, benefits and procedural guidelines for authorization of services.
Conduct on-site visits, telephone conversations and written communications with individuals including Hospital executives, Patient Account Managers, Physicians, Office and Billing Managers.
Perform on-site provider orientations and group county orientations for new primary care, and specialty care physicians regarding policies, procedures, billing and company-wide initiatives.
Consults with physician offices to develop training curriculum specific to client process and work flow for optimal use and operation of EHR systems.
Analyzes workflow by observing customer operations for three days and configures system to the customer's workflow.
Maps customer's data from current system to new EHR system.
Represent the Provider Relations Department and Practice Transformation Specialist in work groups and committees that address both internal and external customer concerns regarding the operations of The Healthcare Network as it pertains to the provider community.
Other duties as assigned.
Applicant must be highly proficient and creative at identifying and solving problems.
Incumbent must be able to work independently as a telecommuter and attend off-site meetings; including overnight stays.
Essential Job Functions:
Communicate effectively as a liaison between the provider community and PBACO in order to provide education on policies and procedures as well as, to assist in the resolution of issues or concerns a provider may have.
Provider Orientations:
Perform on-site provider orientations for primary care, specialty care physicians regarding policies, procedures, billing and company-wide initiatives within 30 days of becoming credentialed and approved.
Oversee group county provider orientations by determining location, arranging for mailing of invitations and make available at the presentation PBACO provider forms, QI Manuals, directories and the PBACO Provider Office Policy and Procedure Manual, as needed.
Goal/Target Visits:
Service primary care, and specialty care physicians within a specific geographic territory by conducting annual Goal / Target visits for the purpose of continued education regarding policies/initiatives.
Each Provider Relations Representative will schedule minimally one goal visit per year with participating practices in the following specialties:
Primary Care / Specialists Minimum
Qualifications:
2 years' experience required in Provider Relations and/or Managed Care Product Administration Preferred
Qualifications:
Bachelor's degree in Business Administration, Marketing, Health Care Administration or Other Related Degree 2 years' Provider Relations experience or medical office or hospital experience 2 years' exposure to medical claims processing procedures Knowledge and understanding of the dynamics of Managed Care environment, including capitation and reimbursement structure Bilingual:
English/Spanish This Company Describes Its Culture as:
Detail-oriented -- quality and precision-focused Innovative -- innovative and risk-taking Outcome-oriented -- results-focused with strong performance culture Pay Frequency:
Bi weekly or Twice monthly This Job Is:
A job for which military experienced candidates are encouraged to apply A job for which all ages, including older job seekers, are encouraged to apply Work Remotely Yes This Job Is Ideal for Someone Who Is:
Dependable -- more reliable than spontaneous People-oriented -- enjoys interacting with people and working on group projects Autonomous/Independent -- enjoys working with little direction Job Type:
Full-time Pay:
$55,000.
00 - $65,000.
00 per year
Benefits:
401(k) 401(k) matching Dental insurance Flexible schedule Flexible spending account Health insurance Health savings account Paid time off Tuition reimbursement Vision insurance Medical specialties:
Primary Care Schedule:
8 hour shift Supplemental pay types:
Bonus pay
Experience:
Medical Office or Hospital:
2 years (Required) Customer Service:
2 years (Preferred) Managed Care:
2 years (Preferred) Medical Claims Processing:
2 years (Preferred) Provider Relations:
2 years (Preferred) Willingness to travel:
75% (Required) Work Location:
On the road.
Estimated Salary: $20 to $28 per hour based on qualifications.
Serve as the primary liaison between The Healthcare Network and the participating provider community who service our members in multiple product lines throughout New Jersey area - mostly Atlantic & Ocean counties on the East coast of NJ.
Build and maintain strong relationships with providers by offering excellent customer service to assigned primary care, and specialty care physicians with routine and targeted education visits for the purpose of continued education regarding policies/initiatives.
Service also includes supply deliveries and prompt follow up regarding claims, benefits and procedural guidelines for authorization of services.
Conduct on-site visits, telephone conversations and written communications with individuals including Hospital executives, Patient Account Managers, Physicians, Office and Billing Managers.
Perform on-site provider orientations and group county orientations for new primary care, and specialty care physicians regarding policies, procedures, billing and company-wide initiatives.
Consults with physician offices to develop training curriculum specific to client process and work flow for optimal use and operation of EHR systems.
Analyzes workflow by observing customer operations for three days and configures system to the customer's workflow.
Maps customer's data from current system to new EHR system.
Represent the Provider Relations Department and Practice Transformation Specialist in work groups and committees that address both internal and external customer concerns regarding the operations of The Healthcare Network as it pertains to the provider community.
Other duties as assigned.
Applicant must be highly proficient and creative at identifying and solving problems.
Incumbent must be able to work independently as a telecommuter and attend off-site meetings; including overnight stays.
Essential Job Functions:
Communicate effectively as a liaison between the provider community and PBACO in order to provide education on policies and procedures as well as, to assist in the resolution of issues or concerns a provider may have.
Provider Orientations:
Perform on-site provider orientations for primary care, specialty care physicians regarding policies, procedures, billing and company-wide initiatives within 30 days of becoming credentialed and approved.
Oversee group county provider orientations by determining location, arranging for mailing of invitations and make available at the presentation PBACO provider forms, QI Manuals, directories and the PBACO Provider Office Policy and Procedure Manual, as needed.
Goal/Target Visits:
Service primary care, and specialty care physicians within a specific geographic territory by conducting annual Goal / Target visits for the purpose of continued education regarding policies/initiatives.
Each Provider Relations Representative will schedule minimally one goal visit per year with participating practices in the following specialties:
Primary Care / Specialists Minimum
Qualifications:
2 years' experience required in Provider Relations and/or Managed Care Product Administration Preferred
Qualifications:
Bachelor's degree in Business Administration, Marketing, Health Care Administration or Other Related Degree 2 years' Provider Relations experience or medical office or hospital experience 2 years' exposure to medical claims processing procedures Knowledge and understanding of the dynamics of Managed Care environment, including capitation and reimbursement structure Bilingual:
English/Spanish This Company Describes Its Culture as:
Detail-oriented -- quality and precision-focused Innovative -- innovative and risk-taking Outcome-oriented -- results-focused with strong performance culture Pay Frequency:
Bi weekly or Twice monthly This Job Is:
A job for which military experienced candidates are encouraged to apply A job for which all ages, including older job seekers, are encouraged to apply Work Remotely Yes This Job Is Ideal for Someone Who Is:
Dependable -- more reliable than spontaneous People-oriented -- enjoys interacting with people and working on group projects Autonomous/Independent -- enjoys working with little direction Job Type:
Full-time Pay:
$55,000.
00 - $65,000.
00 per year
Benefits:
401(k) 401(k) matching Dental insurance Flexible schedule Flexible spending account Health insurance Health savings account Paid time off Tuition reimbursement Vision insurance Medical specialties:
Primary Care Schedule:
8 hour shift Supplemental pay types:
Bonus pay
Experience:
Medical Office or Hospital:
2 years (Required) Customer Service:
2 years (Preferred) Managed Care:
2 years (Preferred) Medical Claims Processing:
2 years (Preferred) Provider Relations:
2 years (Preferred) Willingness to travel:
75% (Required) Work Location:
On the road.
Estimated Salary: $20 to $28 per hour based on qualifications.
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