Provider Relations Representative (Managed Care)

Umass Memorial Health Care Worcester , MA 01601

Posted 2 months ago

At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve.

We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.

Requisition #: 192244

Title: Provider Relations Representative

Department: Managed Care Operations

Posting Date: March 11, 2019

Status: Exempt

Shift: Days

Hours: 40

Location: UMass Memorial Health Care 1 Biotech Park, Worcester, MA

Position Summary:

Performs a variety of duties to assist in ensuring effective customer service and in fostering positive, effective working relationships with providers, health plan payer and hospital staff with regard to health plan policies and procedures, hospital quality improvement initiatives and improving overall physician relations. Maintains effective contact with physicians, hospital staff, and others by attending meetings, telecommunications, through informal and formal office visits, etc.

Position Qualifications:

Requires knowledge of managed care principles and database applications. Knowledge of a variety of business applications software packages with particular proficiency in database software such as Access preferred.

Requires excellent verbal and written communication skills. Bachelor's degree in Business Administration or related discipline and two to three years of relevant experience.

Major Responsibilities:

Assists in identifying issues requiring intervention and or communication to physician offices and hospital staff such as, managed care plan referral requirements, health plan related administrative and operational procedures, and hospital quality improvement initiatives.

Assists in resolving issues based on health plan and hospital standard policies and procedures while incorporating provider's feed back. Assists in developing and implementing a communication plan and follows up on physician and staff concerns.

Works with physician/office staff to address issues and concerns related to hospital initiatives, health plan policy and procedure changes or overall educational areas of improvement by attending health plan meetings, speaking with physician and hospital office staff and implementing surveys. Assists in developing communications and educational tools for inservice trainings, health plan forums, orientation updates, physician and office workshops, provider handbooks and news bulletins.

Reports issues requiring intervention. Investigates causes for recurring problems and helps resolve hospital and physician health plan issues.

Works with Physician Enrollment and Credentialing office to prepare information for credentialing committees relating to new physician applications

Works with database applications for reporting and assists in developing new reports to accommodate business reporting needs.

Complies with established departmental policies, procedures, and objectives.

Attends variety of meetings, conferences, and seminars as required or directed.

Demonstrates use of quality improvement in daily operations.

Complies with all health and safety regulations and requirements.

Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

We're striving to make respect a part of everything we do at UMass Memorial for our patients and for each other. We're expecting that our new caregivers practice our six Standards of Respect: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player, and Be Kind, to help us make respect a part of how we take care of business everyday.



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Provider Relations Representative (Managed Care)

Umass Memorial Health Care