Provider And Payer Relations Specialist

The Polyclinic Seattle , WA 98113

Posted 1 week ago

Hours: Full Time; Monday - Friday; 8:00 - 4:30

Location: The Polyclinic 1145 Broadway

POSITION OBJECTIVE:

Lead all external professional relationship management with provider organizations and health insurance company personnel, in addition to internal PCA and PCN boards, leadership, directors and managers. Collaborate with these external organizations to assist in carrying out their goals and objectives. Interface with high level internal/external contacts requiring considerable discretion and initiative.

RESPONSIBILITIES:

Relationship Management

  • Manage communication and relationship collaboration between team members of PCA and PCN, health insurance plans, and provider organizations

  • Administer communication tools with external parties, including owning SharePoint site

  • Responsible for managing issue resolution with clinics by collaborating with clinic administration and PCA and PCN teams

  • Proactively engage providers identifying; educational opportunities that decrease administrative burden, ensure provider compliance to contract terms, and enhance performance

  • Develop and maintain relationship with health insurance personnel to resolve issues and communicate needs to/from the PCA and PCN teams

  • Ensure timely management of issues within the team and communication of priorities

  • Provide the voice of the clinic administration to PCA and PCN administration

  • Responsible for leading JOC meetings including ensuring attendee invitation and managing attendee lists

  • Manage accurate provider rosters and participating group contact information

  • Correspond with members of physician organizations regarding billing and credentialing needs

  • Work with PCA and PCN team members to develop and deliver interim reports and statistics to physician organizations

  • Provide communication and support for affiliate physician organizations as needed

  • Monitor and deliver on PCA and PCN needs and obligations regarding patients that are outside of signed insurance contracts

  • Understand relationships and referral patterns within territory, contract terms, and reimbursement methodologies

  • When necessary, attend and represent PCA and/or PCN at provider network events and functions

Payer Liaison

  • Work directly with Director of Contracting and Contracts Specialist to coordinate contract negotiations and analysis

  • Track, reconcile, and report provider enrollment lists and attribution differences between health insurance and PCA signed physician organizations

  • Manage attribution information and collaborate with the PCA and PCN teams for follow up: the finance department for needs related to financial forecasting and payment reconciliation, the data analytics team for reporting, and the population health and practice transformation teams for quality improvement needs

  • Analyze, distribute, and monitor payer specific data requests with PCA and PCN provider organizations

  • Liaise with payers to ensure timely transmission of data including claims, enrollment files, baseline and ongoing performance data

Network Strategy

  • Execute and support the development of engagement strategies

  • Identify and initiate communication with potential future network participants

Contract Maintenance

  • Disseminate, collect, and track all contracts and Business Associate Agreements from all PCA and PCN physician organizations.

  • Monitor deadlines for insurance contracts and addendums.

Other duties as assigned.

Requirements

QUALIFICATIONS:

Education: A minimum of college Bachelor's degree

Certification/Licensure: Not required

Experience:

  • Demonstrated provider relationship management experience with senior level management and personnel

  • Prior experience working in the health care industry; either in insurance, medical products, or in the business or marketing department at a provider organization

  • Requires prior experience in marketing and/or public relations

Skills:

  • Excellent communication and negotiation skills

  • Exceptional organizational and planning ability to manage multiple projects

  • Aptitude to prioritize work demands and exercise independent discretion to reflect management team's style and company policy

  • Computer skills (typing 70+ words per minute, Outlook, Word, Access, Excel, PowerPoint) with ability to produce high quality documents

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Provider And Payer Relations Specialist

The Polyclinic