Practitioner Relations Representative

Customer Service Fort Worth, Texas Carmel, Indiana


Description

American Specialty Health Incorporated is seeking a Practitioner Relations Representative to join our Practitioner Contracting Services department. The primary purpose of this position is to make outbound calls and survey and educate contracted practitioners to ensure compliance is met efficiently and effectively and to deliver high quality customer service.

Responsibilities

  • Outreach to at least 75% of practitioner network by making secret shopper outbound calls and practitioners who we are unable to locate to meet regulatory requirements.
  • Provider screening and data entry for new Medi-Cal/Medicaid regulatory requirements.
  • Handles incoming calls regarding secret shopper survey and provider directory validation, and follow up with response and tracked into database and/or spreadsheets.
  • Prepare survey data reports with tracked responses for auditing purposes.
  • Outreach to a list of providers to validate directory listing data to for NCQA auditing to ensure regulatory requirements are met for the network.
  • Handles complex responses that require research to achieve appropriate resolution.
  • Captures practitioner responses and enter into database/spreadsheets.
  • Captures practitioner change information, documents and forwards as required to record changes in appropriate databases.
  • Handles necessary administrative duties to properly support, document and resolve practitioner inquires.
  • Outbound calls to resurvey practitioners who failed initial survey response and follow-up.
  • Maintains confidentiality of practitioner files, participation data, practitioner records/documents and all discussions relative to recruiting, contracting, and credentialing processes.
  • Attends department and all-staff meetings to increase knowledge and foster teamwork.

Qualifications

  • Associate’s degree or equivalent preferred. If equivalent experience, high school diploma required.  
  • Minimum two years of progressive experience performing customer service duties.
  • Specialty health care or health care experience preferred. 
  • Proficient in MS Office with experience in word processing and spreadsheet applications.

Core Competencies

  • Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
  • Ability to exercise strict confidentiality in all matters.

Mobility

Primarily Sedentary, able to sit for long periods of time.

Physical Requirements

Ability to speak, see and hear other personnel and/or objects.  Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law. 

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.