Provider Relations Representative

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Job Title: Provider Relations Representative Department: Physician Provider Partnerships
Reports To: Jennifer Cockerham Supervisory: No
Travel: Yes Job Location: Remote

 

HR Use Only:
Classification/Status: 
Exempt                            EEOC Category: Professional

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POSITION SUMMARY

CCPN is a physician-led, clinically integrated network of independent primary care clinicians. The Provider Relations Team is comprised of field-based experts, accountable for ensuring the CCPN network delivers high quality care and is successful in a value-based care environment.

The Provider Relations Rep must maintain an in-depth understanding of health plan contracts, operations, policies and procedures as their main responsibility is to ensure the practices meet all contract obligations and health plan expectations.

CCPN is committed to developing and implementing a robust provider relations team and strategy state-wide with the understanding that provider relations staff will be assigned to regions to enhance the local presence and support.

Essential Functions

  • Responsible for partnering with local teams to build, nurture and maintain positive working relationships with CCPN practices in the assigned region.
  • Deliver exceptional customer service.
  • Serve as the primary point of contact and resolution to and assist practices in navigating a complex healthcare delivery system with a seamless approach to managing multiple contract obligations and deliverables.
  • Engage practices in ongoing initiatives; present features, benefits and clearly communicate how the initiative aligns with and supports value based healthcare.
  • Develop and deliver educational offerings to clinicians and practices as required by contracts and as needed to facilitate contract obligations and deliverables are met.

Key Activities

  • Daily travel to clinicians’ offices within the assigned regions.
  • Proactively develop and maintain relationships with all clinicians and support staff.
  • Anticipate, investigate and resolve clinician issues.
  • Implement processes to decrease administrative burden for the practice.
  • Make certain practices have appropriate access to services and understand contract requirements and obligations.
  • Make practices aware of existing and new services, products, and opportunities made available to them through CCPN.
  • Understand and support quality improvement efforts to prepare practices for value based delivery of services and improve overall patient care and clinical outcomes.
  • Use data and analytical skills to develop and implement methods to improve performance and relations with practices / clinicians.
  • Link practices with other services and resources such as care management, care coordination, clinical programs, community resources and supports to assist with social determinants of health.
  • Coordinate joint partner/practice visits and communicate with all team members as needed.
  • Attend conferences, local and state meetings that support networking with clinicians and support staff.
  • Remain visible within the community by collaborating face to face with providers and partners by serving on local communities and by frequent interactions with related agencies.
  • Orient and educate clinicians and practices on all applicable contract requirements, including but not limited to: policies, procedures, guidelines, operations, contract requirements, clinical programs, billing and coding, MOC, CME, etc.
  • Travel to Raleigh to attend team meetings, trainings and planning sessions (if located regionally outside of the Triangle area).

Requirements

  • Excellent interpersonal and collaboration skills with ability to drive issues to resolution
  • Timely and comprehensive documentation of accounts, visits, activities, etc.
  • Excellent verbal and writing communication skills, with an ability to translate complex ideas into clear, easy-to-understand concepts
  • Strong conflict resolution, negotiation, consensus building skills
  • Independence, initiative, resourcefulness, and an attitude of teamwork and service
  • Superior analytical, facilitation, and liaison skills
  • Ability to prioritize work, manage multiple priorities, deliver quality work on time and escalate effectively

Education and Experience

  • Bachelor’s degree in health care or related field
  • 3 – 5 years of experience working in Provider Relations or Managed Care
  • Experience with Provider Network Management to include contract compliance
  • Experience with Medicare, Medicaid, and commercial health insurance plans
  • Trained in RAF Scores, Star Metrics, Care Gaps, billing and coding best practices to optimize revenue
  • Previous experience working with population health, advanced payment models (ACOs, Medicare Shared Savings Plans) and other new value-based healthcare models
  • Trained in Academic Detailing principles, Motivational Interviewing, and other related sales techniques necessary to effectively engage and provide services to primary care practices

Working Conditions

This job description describes the general nature and level of work to be performed and is not meant to be comprehensive of all duties and responsibilities to be performed by the person filling this job function.