Provider Relations Representative

Evaluates assigned territories and negotiates contracts with physicians, specialists, ancillary providers and hospitals within the GA Metro August Area (Richmond, Columbia, McDuffie, Lincoln and Burke Counties)

Essential Functions & Responsibilities

  • Target potential providers to establish contractual agreements.
  • Analyzes and evaluates assigned territories for recruitment needs,
  • Recruits and contracts physicians, specialists, ancillary providers and hospitals for HN1 with inclusion of al necessary documentation, i.e. credentials, site visits.
  • Researches and solves any questions or concerns that providers may have.
  • Negotiates contracts for HN1 with inclusion of all necessary documentation, i.e. credentials.
  • Works with contracted providers to integrate their services into the overall care delivery network.
  • Maintain lines of communications with all internal departments and with all participating providers in enlisting their assistance in referring potential providers in the Network.
  • Organize reports for presentation to senior management staff.
  • Support other departments as needed.
  • Expedites and researches provider’s utilization data with reference to negotiating new rates.
  • Responsible for conducting site visits of all newly contracted providers.
  • Supports Credentialing Department by assisting with the collection of physician credentials for re-credentialing purposes.
  • Maintains and updates physician files.
  • Evaluates claim data on recently contracted providers, ensuring contract is profitable for Company.
  • Respond to provider inquiries regarding contracts, provider networks and HN1 operations.
  • Complies with all Company HIPAA polices and procedures.
  • Ensures integrity of data entered into company systems and/or databases.
  • Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
  • Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
  • Ability to come to work and work the regular schedule and shift for the position.
  • Compliance with all personnel policies and procedures.
  • Perform additional duties and related essential duties as assigned.

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Required Education and Experience

  • Associate's degree (A. A.) or equivalent from two-year college or technical school; and two to three years experience in physician's office, HMO's or other Health Care institutions.

Qualifications

  • Must be able to travel within their territories 80% of the time.
  • Candidate must reside in Georgia.
  • Territory: GA Metro August Area (Richmond, Columbia, McDuffie, Lincoln and Burke Counties)

Other Skills and Abilities

  • Bilingual is preferred but not mandatory.
  • Knowledge of physician office procedures.
  • Knowledge of medical terminology, CPT coding, billing procedures.
  • Strong Organizational skills.

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