Provider Relations Specialist - Provider Relations

Sanford Health Fargo , ND 58102

Posted 2 weeks ago

Job Title: Provider Relations Specialist | Provider Relations | Fargo

City: Fargo

State: North Dakota

Department : Provider Relations

Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr

JOB SUMMARY

The Provider Relations Specialist acts as the primary liaison between the Health Pan and its network providers, including physicians, hospital, and ancillary services. Responsible for daily communication with providers with respect to questions, concern, and complaints and therefore must have a broad understanding of the substantive and procedural aspects of the Health Plan.

Knowledge of Managed Care-utilization management and provider reimbursement. Must be able to communicate effectively and with a high level of diplomacy with providers. Must assimilate large amounts of information to maintain a broad knowledge base.

Should exercise good judgement in determining best methods of handling a variety of situations. Handles pressure effectively while maintaining confidentiality. Supports, develops and maintains relationships with provider networks.

Responds to providers regarding policies, rates, changes, eligibility, credentialing etc. Occasionally train others regarding policies, procedures, online tools and other resources.

POSITION RESPONSIBILITIES

Ensures identification of customer needs and priorities. Communicates well downward, upward, and outward.

Responds to day-to-day operational priorities while still making progress on project work. Learns new concepts, processes and tools related to own immediate responsibilities. Actively participates in team meetings.

Maintains a sense of urgency and a positive attitude. Uses the Office document collaboration features in a workgroup. Uses logic and intuition to make inferences about the meaning of the data and arrive at conclusions.

Contributes to the establishment of good coaching practices. Processes large quantities of detailed information with high levels of accuracy. Identifies information within own function that cannot be disclosed.

DEPARTMENT DETAILS

Responsible for inbound phone calls from provider offices regarding inquiries on claim status, claim payments, and general inquires. Reviews and documents claim reconsideration requests.

Strong computer skills to be able to navigate quickly between multiple systems. Effective communications skills.

QUALIFICATIONS

Bachelors degree in Human Resources, Business or related field required. Marketing/Sales training preferred.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing. Every day, we show that commitment by delivering the highest quality of care to the communities we serve. We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth. We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases. We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities. We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

In compliance with federal law requiring employers to verify new employees' U.S.

employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterEnglish.pdf or here for Spanish Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterSpanish.pdf .

City: Fargo

State: North Dakota

Job Function: Health Plan

Job Schedule: Full Time

Shift: Days

Req Number: req24511



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