Univera Healthcare
Provider Relations Representative (Buffalo/WNY Territory)
Univera Healthcare, Buffalo, New York, United States, 14266
Provider Relations Representative (Buffalo/WNY Territory)
Join to apply for the Provider Relations Representative (Buffalo/WNY Territory) role at Univera Healthcare. Job Description: This position serves as the primary contact between providers and the organization. The position is responsible for servicing assigned providers within a defined geographic market. Key responsibilities include educating and servicing physicians, dentists, hospitals, and ancillary providers within established guidelines. This position works closely with all other internal departments including sales, medical, operations, and network management. As a key representative of the corporation, this position is expected to maintain strong communication and build positive working relationships with local physicians, hospitals, and ancillary providers. Candidate must reside in the Buffalo/WNY area in order to be considered. Level I:
Recruit and retain all provider types to ensure network adequacy. Facilitates provider education and training through documented face‑to‑face visits, educational forums, and orientations to increase providers’ knowledge and satisfaction with contract terms, benefits products, policies, programs, systems, new programs, and products. Provides orientation and training for all newly enrolled providers and their staff as well as annual training to the overall provider community. Educates providers on care management programs, policies, and quality initiatives including UM programs, case and disease management, HEDIS, and paid‑for‑performance (P4P) to improve compliance and participation. Coordinates with medical services to analyze and present data to providers to improve participation and/or compliance within established programs and enhance member health status. Builds physician, provider, and facility satisfaction by conducting service visits both in response to provider requests and proactively on behalf of the organization. Plans, initiates, develops, coordinates, schedules, and documents visits in conformance with department standards and geographic assignment. Maintains awareness of competitive activity through relationships developed with providers and their office staff. Documents and shares market position intelligence on a monthly basis to position the organization favorably and respond to provider needs. Provides expertise and assistance with guidelines relative to provider billing and payment, encouraging participation with programs and procedures designed to create operational efficiencies. Ensures changes in billing procedures are communicated timely to all providers. Provides accurate feedback to internal departments to improve accuracy of system interfaces. Serves as an internal expert and develops working relationships with internal departments to facilitate workflows and coordinate resources for provider problem resolution. Identifies and communicates trends that impact provider satisfaction. Supports the development of effective provider tools and communications. Creates and maintains information such as provider manuals, newsletters, mailings, provider directories, and other education and publication materials distributed by the organization to providers. Ensures processes are documented to support business maintenance. Assists with training and mentoring of peer Provider Relations Representatives as needed to ensure departmental success. Provides project management support as needed. Assists in developing and coordinating provider educational activities. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management.
Level II (in addition to Level I Accountabilities):
Represents the Provider Relations department on Health Plan projects/initiatives. Represents the Provider Relations department at Regional and Health Plan meetings as assigned by management. Develops, coordinates, and leads provider educational activities. Acts as the subject‑matter expert and point of contact for the department. Provides leadership and guidance to junior Provider Relations Representatives.
Level III (in addition to Level II Accountabilities):
Leads Health Plan projects/initiatives that have a direct impact on improving provider satisfaction. Leads Provider Relations efforts to drive network and quality improvement. Represents Provider Relations Management, as assigned, in governance structure forums and strategic projects. Develops and nurtures positive relationships with strategic high‑profile providers, including full health system, provider partners and ACQA providers.
Minimum Qualifications (All Levels): Bachelor’s degree in Business Administration, Health Care Administration, or a relevant field. Minimum of two (2) years of relevant and progressive business experience working in managed care or other health‑care related fields with significant interface with physicians and hospitals. In lieu of a degree, experience that includes handling escalated executive inquiries, training, and/or presentations for staff or external customers. Demonstrated experience with moderately complex projects that involve written and verbal responses to physician or hospital inquiries. Strong, persuasive and effective communication skills, including experience delivering communication to physicians and hospitals. Experience in preparing and delivering oral presentations to individuals and small and large group audiences. Understanding of medical care delivery and local market dynamics. Familiarity with provider contracts and operational policies and procedures. Understanding of products and services offered to members. Understanding of claim processing systems including provider file and claim workflows. Knowledge of care management programs and their impact on providers and members. Strong interpersonal skills to interface effectively externally and internally with a wide range of people including physicians, office staff, and other health plan staff. Excellent problem‑solving skills with effective follow‑through. Strong verbal and written communication skills; organizational and project management skills. Level II (in addition to Level I Qualifications): Minimum of four (4) years of relevant and progressive business experience working in managed care or other health‑care related fields with significant interface with physicians and hospitals. Demonstrated experience with complex and high‑profile projects that involve written and verbal responses to physician or hospital inquiries. Working knowledge of provider contracts and operational policies and procedures. Level III (in addition to Level II Qualifications): Minimum of six (6) years of relevant and progressive business experience working in managed care or other health‑care related fields with significant interface with physicians and hospitals. Demonstrated experience with highly complex and high‑profile projects that involve written and verbal responses to physician or hospital inquiries. Subject‑matter expert in care management programs and their impact on providers and members. Physical Requirements: Ability to travel across the health plan service regions as needed. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): N7 Min: $23.56 - Max: $37.70 N8 Min: $26.89 - Max: $43.02 N9 Min: $29.57 - Max: $47.32 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, paid holidays.
#J-18808-Ljbffr
Join to apply for the Provider Relations Representative (Buffalo/WNY Territory) role at Univera Healthcare. Job Description: This position serves as the primary contact between providers and the organization. The position is responsible for servicing assigned providers within a defined geographic market. Key responsibilities include educating and servicing physicians, dentists, hospitals, and ancillary providers within established guidelines. This position works closely with all other internal departments including sales, medical, operations, and network management. As a key representative of the corporation, this position is expected to maintain strong communication and build positive working relationships with local physicians, hospitals, and ancillary providers. Candidate must reside in the Buffalo/WNY area in order to be considered. Level I:
Recruit and retain all provider types to ensure network adequacy. Facilitates provider education and training through documented face‑to‑face visits, educational forums, and orientations to increase providers’ knowledge and satisfaction with contract terms, benefits products, policies, programs, systems, new programs, and products. Provides orientation and training for all newly enrolled providers and their staff as well as annual training to the overall provider community. Educates providers on care management programs, policies, and quality initiatives including UM programs, case and disease management, HEDIS, and paid‑for‑performance (P4P) to improve compliance and participation. Coordinates with medical services to analyze and present data to providers to improve participation and/or compliance within established programs and enhance member health status. Builds physician, provider, and facility satisfaction by conducting service visits both in response to provider requests and proactively on behalf of the organization. Plans, initiates, develops, coordinates, schedules, and documents visits in conformance with department standards and geographic assignment. Maintains awareness of competitive activity through relationships developed with providers and their office staff. Documents and shares market position intelligence on a monthly basis to position the organization favorably and respond to provider needs. Provides expertise and assistance with guidelines relative to provider billing and payment, encouraging participation with programs and procedures designed to create operational efficiencies. Ensures changes in billing procedures are communicated timely to all providers. Provides accurate feedback to internal departments to improve accuracy of system interfaces. Serves as an internal expert and develops working relationships with internal departments to facilitate workflows and coordinate resources for provider problem resolution. Identifies and communicates trends that impact provider satisfaction. Supports the development of effective provider tools and communications. Creates and maintains information such as provider manuals, newsletters, mailings, provider directories, and other education and publication materials distributed by the organization to providers. Ensures processes are documented to support business maintenance. Assists with training and mentoring of peer Provider Relations Representatives as needed to ensure departmental success. Provides project management support as needed. Assists in developing and coordinating provider educational activities. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with corporate privacy policies and procedures. Regular and reliable attendance is expected and required. Performs other functions as assigned by management.
Level II (in addition to Level I Accountabilities):
Represents the Provider Relations department on Health Plan projects/initiatives. Represents the Provider Relations department at Regional and Health Plan meetings as assigned by management. Develops, coordinates, and leads provider educational activities. Acts as the subject‑matter expert and point of contact for the department. Provides leadership and guidance to junior Provider Relations Representatives.
Level III (in addition to Level II Accountabilities):
Leads Health Plan projects/initiatives that have a direct impact on improving provider satisfaction. Leads Provider Relations efforts to drive network and quality improvement. Represents Provider Relations Management, as assigned, in governance structure forums and strategic projects. Develops and nurtures positive relationships with strategic high‑profile providers, including full health system, provider partners and ACQA providers.
Minimum Qualifications (All Levels): Bachelor’s degree in Business Administration, Health Care Administration, or a relevant field. Minimum of two (2) years of relevant and progressive business experience working in managed care or other health‑care related fields with significant interface with physicians and hospitals. In lieu of a degree, experience that includes handling escalated executive inquiries, training, and/or presentations for staff or external customers. Demonstrated experience with moderately complex projects that involve written and verbal responses to physician or hospital inquiries. Strong, persuasive and effective communication skills, including experience delivering communication to physicians and hospitals. Experience in preparing and delivering oral presentations to individuals and small and large group audiences. Understanding of medical care delivery and local market dynamics. Familiarity with provider contracts and operational policies and procedures. Understanding of products and services offered to members. Understanding of claim processing systems including provider file and claim workflows. Knowledge of care management programs and their impact on providers and members. Strong interpersonal skills to interface effectively externally and internally with a wide range of people including physicians, office staff, and other health plan staff. Excellent problem‑solving skills with effective follow‑through. Strong verbal and written communication skills; organizational and project management skills. Level II (in addition to Level I Qualifications): Minimum of four (4) years of relevant and progressive business experience working in managed care or other health‑care related fields with significant interface with physicians and hospitals. Demonstrated experience with complex and high‑profile projects that involve written and verbal responses to physician or hospital inquiries. Working knowledge of provider contracts and operational policies and procedures. Level III (in addition to Level II Qualifications): Minimum of six (6) years of relevant and progressive business experience working in managed care or other health‑care related fields with significant interface with physicians and hospitals. Demonstrated experience with highly complex and high‑profile projects that involve written and verbal responses to physician or hospital inquiries. Subject‑matter expert in care management programs and their impact on providers and members. Physical Requirements: Ability to travel across the health plan service regions as needed. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): N7 Min: $23.56 - Max: $37.70 N8 Min: $26.89 - Max: $43.02 N9 Min: $29.57 - Max: $47.32 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, paid holidays.
#J-18808-Ljbffr