Provider Relations Rep I Valley

Where compassion meets innovation and technology and our employees are family.

General Purpose of Job:

The Provider Relations Representative serves as the liaison between health care providers and Driscoll Health Plan; responsible for provider/facility initial orientation, ongoing education and problem resolution; performs office inspection/site surveys of new providers. Conducts visits with providers and their office staff on a routine basis to ensure open communication between health plan and providers. Also ensures provider demographic information is correct and up-to-date in assigned territory.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or administration as required.

• Maintains utmost level of confidentiality at all times.
• Adheres to hospital and Health Plan policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Communicates the benefits of being a DHP provider.
• Provides timely education to providers and provider’s staff concerning contract requirements, DHP provider manual, policies and procedures, and claim submission guidelines.
• Provides timely education to providers and provider's staff on DHP electronic submission of claims, Electronic Funds Transfer processes, and web portal functions.
• Establish good working relationships with providers and provider offices in resolving issues to include being a trusted advocate for the provider.
• Establish a schedule of provider workshops to include specialty specific education.
• Assists providers with incentive programs, as applicable.
• Develop and implement a balanced scorecard metric.
• Assist the Contracting and Credentialing Departments as necessary.
• Document provider calls to include an Issues Log for monthly reporting.
• Develop and maintain a process for provider notification to include physician changes (moves, leaves practice, join practice, etc).
• Communicates in both written and oral form with contracted professionals, individuals, on behalf of the physicians/Health Plan in order to obtain or relay information.
• Maintains up to date knowledge of physician contracts, claims and billing.
• Is detail oriented with exceptional presentation skills, ability to complete multiple projects and meet deadlines.
• Maintains excellent verbal and written communication skills, proficient computer skills helpful.
• Ability to provide prompt, courteous and excellent customer service to providers.
• Assists the CEO, CFO, Medical Director(s), Directors, or other staff as needed.
• Performs other duties as requested.

Education and/or Experience:

• Licensure: Valid driver's license required.
• Two years’ experience in healthcare, medical provider or customer relations required.
• Minimum of 3 years’ experience in a Provider Relations role, preferably with a health plan or
  provider network preferred.
• At least a high school education with college degree preferred.