Provider Relations Representative

Summary:
The Provider Relations Representative functions as a single point of contact for iCircle’s Provider Network and any community organization that does business with iCircle or it’s members. Provider Relations Representatives (PR) are responsible to ensure that all provider assistance, orientations, site visits, and general interactions are successfully completed within established timeframes. PR Reps will often provide direct assistance with the various other Provider Network/iCircle Departments to ensure compliance & completion of contracting items, credentialing items, claim projects, networking and general business relations, Clinical Coordination, etc. to name a few. Likewise, the PR Reps will provide assistance to iCircle’s Clinical team if / when discussions are needed with contracted providers or community organizations to assist in providing iCircle members with the highest quality of care / assistance.

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Essential Job Functions: *

• Operate as a single point of contact for provider contracts, vendor management, provider relations, and provider credentialing by means of being the point-person for contact purposes within covered counties
• Responsible for annual provider training and to educate providers on policies and procedures as needed
• Provide assistance, as needed, with the Credentialing of new providers and re-credentialing of existing providers
• Provide assistance, as needed, for iCircle Contracting staff to grow/develop iCircle’s Network of Contracted Providers to ensure an adequate network is in place for covered counties and to help expand the organization.
• Interface with providers and facilities regarding adequacy of coverage and needs
• Assure all provider orientations, site visits, access, and availability studies are completed within designated time frames. Assure all providers are visited within established time frames
• Provide support to investigate provider complaints or member complaints about providers to maintain member and provider satisfaction. Ensure provider issues/complaints are resolved following all policy and procedures, NYS regulations, NYS MLTC contract, and future Products
• Establish and foster strong, positive relationships with key providers by coordinating, facilitating, and leading partnership meetings and identifying on site enrollment opportunities for marketing
• Proactively identify provider needs or concerns and advise management so that action can be taken
• Prepare and deliver Provider correspondence when necessary while ensuring plan compliance
• Review billing and claims issues in coordination with iCircle’s Claim department to assist with resolution
• Initiate marketing and sales opportunities to increase provider network. High visibility in the community
• Maintains a knowledge base of all programs iCircle Services offers and communicates valued outcomes and benefits to providers and referral agents
• Contribute to retention rate of members and providers through good stewardship, coordination and partnerships
• Maintain a daily log and report of all contacts, presentations, and outcomes. Responsible for completing required networking and provider relations reports for internal review as needed
• Follows all NYS DOH regulations and standards for marketing and contracting activities
• Travel to Providers, Networking Groups, Site Visits, etc. may be required in order to complete some of the required attributes of this position, which may involve utilizing personal vehicles or iCircle owned vehicles when available
• Depending on department and/or Organizational needs, this position may require the representative to be able to work remote, at a designated office, or a combination of both depending on needs
• Perform all other duties relevant to the position as assigned by supervisor

Knowledge, Skills, and Abilities

• Experience in applying the organizations mission and vision when developing requests for proposals, negotiating terms, and drafting correspondence as needed
• Experience in ensuring providers are credentialed, appointed, and privileged
• Reliable transportation (NYS Drivers??? Licensed required) with ability to travel to conduct business as needed.
• Ability to communicate effectively, both orally and in writing
• Ability to lift at least 25 lbs.; lifting of over 25 lbs. with assistive devices
• Maintain all required certifications/training by State regulations as well as iCircle and CDS Life Transitions’ policy

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Education and Experience: *

• Bachelor’s Degree in a health care, business, or marketing related field
• Prior work experience with contracts, credentialing, PR or Business Development preferred
• Experience in Medicaid or Medicare Managed care insurance plans preferred

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The statements herein are intended to describe the general nature and level of work being performed, but are not to be seen as a complete list of responsibilities, duties, skills, required of personnel so classified. Also, they do not establish a contract for employment and are subject to change at the direction of the employer._

Job Type: Full-time