The Senior Provider Engagement Representative is field-based and is responsible for building and maintaining partnerships with Physicians, Hospitals, Ancillaries, and large or complex Physician organizations (Providers). Ensures consistent communication, support, and education to Providers on relevant topics, including but not limited to identified claims and/or authorization issues, new initiatives, availability and functionality of Community's Provider Portal. Primary lead for Joint Operating Meetings of assigned Providers. Serves as a subject matter expert in Community's incentive program(s); requests, analyzes and reviews provider-specific reports; offers alternatives and/or resolutions to undesirable report findings. Identifies and disseminates best practices within the Network and adheres to the Provider Communication and Interaction Guidelines. Collaborates with leadership, co-workers, and staff in other departments to achieve departmental and organizational objectives.
- Education/Specialized Training/Licensure:
- High School or equivalent required.
- BA/BS in Business preferred
- Work Experience (Years and Area):
- 5 years' experience in managed care (Provider Relations/Services; Claims Adjudication, Medical Coding, Contracting)
- Software Operated:
- Microsoft Office (Word, Excel, PowerPoint)
- QNXT and CACTUS system preferred
- Other Requirements:
- Must have valid driver's license and car insurance.
- Exhibit excellent communication and interpersonal skills by demonstrating solid verbal and written communication skills with internal and external customers ensuring that both oral and written communications are both constructive and professional at all times.
**This position will be supporting the Provider network in the Beaumont, Texas area. Must be willing/able to be based in this area. **
RESPONSIBLE TO: Director
EMPLOYEE SUPERVISED: None