Provider Network Management Relations Service Associate

Overview

Now hiring a Provider Network Management Relations Service Associate

Primarily responsible for supporting the Network Relations Service Executive. With limited supervision responds to and resolves complex issues related to daily operations. The Network Relations Service Associate assists with data collection and distribution of clinical quality measures to the provider network in accordance with PHP s quality and incentive programs. Ensures providers receive exceptional service when responding to inquiries. The position assures an exceptional provider experience in support of organizational service goals including provider satisfaction and retention through ongoing network relationship development and management. Acts as a resource and advocate for the provider network offering guidance, training, and problem resolution ensuring data integrity and compliance with regulatory and compliance standards

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: No
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate 

• High School diploma or GED required. One to three years of experience in provider relations, provider contracting, claims processing experience, or customer service in a healthcare organization.

Qualifications

• High School diploma or GED required. One to three years of experience in provider relations, provider contracting, claims processing experience, or customer service in a healthcare organization.
• Superior oral, written, interpersonal skills required to interface with providers and the providers staff.
• Must also have strong organizational and personal computing skills

Responsibilities

• Provides superior service to all network providers, assisting with resolution of provider issues regarding claims, health services, finance or other Health Plan related issues. This includes reporting, tracking and trending provider calls and complaints, meeting or exceeding service goals defined by organization and business unit, as well as recommending process improvements to enhance the overall service level to providers.
• Responsible for initiating and processing provider changes including demographic, tax id and other related data corrections. Performs data entry as needed.
• Responsible for ensuring provider data integrity and accuracy by completing PIF s timely and accurately.
• Coordinates and assists with meetings, training, contracting, credentialing and reporting.
• Develops and maintains positive provider relationships.
• Collaborates with the Network Service Executive to provide leadership in Network Support Team Meetings, also accepts delegated responsibilities and assignments.
• Assists Network Service Executive with daily issues or concerns, researches complex issues, provides documentation and recommendations for resolutions.
• Acts as a resource to the assigned network for questions or guidance on compliance concerns or other health-plan related issues. Acts as advocate for the assigned network providers assisting with the interpretation of contracts and other related reimbursement issues.
• Engages and supports leadership and peers by promoting and participating in department initiatives and being accountable for achieving business objectives.
• Practices respecting and valuing the differences in each person and demonstrates an inclusive style that fosters dialogue for collaborative solutions

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Maximum Offer for this position is up to

USD $29.22/Hr.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.