Provider Relations Specialist

Under the direction of the Manager of Contracting a n d Network Ma n agement , this position i s r esponsible to ass i st wit h all credentialing and provider relations activities for BFMG/HP N /CCPN. The Provider Relations Specialist wi ll i nteract w i th other departments, c l in i c personnel , a n d outsid e prov i der s i n a profession a l an d f r i en d l y manner, t o create and maintain a posi t i ve relationship w i t h o u r i n t e rna l and ex t erna l customers.

Assist with the updating of Physician Credentialling files and information via Morrissey Credentialing Database and Virtual Provider Database and ensuring accuracy and timeliness of information entered by Medical Staff. Assist with the maintenance of Provider and Ancillary Files by quarterly audits of all files for BFMC/CCPN.

Assist with the revision and updates of the Credentialing Program such that it continuously meets the requirements of HPN, Inc and its contracted Health Plans, National Committee of Quality Assurance (NCQA), State and federal regulations. Work directly with provider office staff to develop and facilitate efficient health care delivery network, resolve issues, and provide continued provider support.

Work as both provider advocate and plan representative; answering questions, identifying and evaluating problems, communicating resolutions in a timely manner. Support user set-up for on-line portal. Assist with periodic provider satisfaction surveys. Posses and demonstrates understanding of the various provider contracts maintained.

Assists with analyzing various reports to monitor provider activity and identify provider problems. 8.1 High School Diploma/ GED equivalent. 8.2 Credentialing experience Will train if necessary. 8.3 Excellent written and oral communication skills. 8.4 Knowledge of correct grammar and English language usage, including punctuation.

8.5 Familiar with Microsoft Office. 8.6 Ability to prioritize work and multitasking. 8.7 Ability to deal responsibly with matters of a confidential nature. The pay range for this position at commencement of employment is expected to be between $26.58 and $31.27. However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.