Provider Relations Representative

Location

Reno, NV | United States

Job description

Responsibilities

Job Summary: Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan. Will assist in the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Supports those who direct and implement strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims; and is responsible for steerage initiatives, site visits, training, educating, and overall communications including portals, webpages, letters, and email messages. Responsible for the oversight and management of Medicare Quality Reporting during each performance year and through the annual reporting periods and ensures resources are in place to complete the annual GPRO reporting requirement.

Qualifications and Requirements:

• BS, Bus Admin, Finance or similar field, or equivalent work history
• 2+ years in HEDIS, ACO, or Care Gap reporting
• 2+ years working with Medicare contracts and regulatory reporting requirements
• 3 years in managed care or medical insurance.
• 2 years working in a clinical setting.
• 1 year in a claims, customer service or provider support role .
• Excellent oral and written English communication skills including telephone etiquette.
• Superior interpersonal skills
• Proficient research, critical-thinking and analytical problem-solving skills
• Intermediate proficiency with Microsoft Office (Excel, Word, PowerPoint, Outlook).
• Self-starter and resourceful with ability to execute projects in a fluid and fast paced environment
• Strong organizational, planning and attention to detail skills.
• Valid Driver’s License, reliable transportation, and proof of insurance required
• Requires local travel and occasional out of area overnight travel required.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.  We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: or 1-800-852-3449 .

Job tags

Salary