In House Provider Relations Representative

Medicare Advantage Health Plan Park Ridge, Illinois


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets, employees.

In-House Provider Relations Representative

Location - Park Ridge, IL

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina through our affiliate, Eon Health (redirects to Eon).

Job Summary:

Provider Relations In-House Representative is responsible supporting Provider Relations Field Reps, maintaining working relationship with the existing provider’s networks.

Main Accountabilities:

  • Maintains regular contact with key provider organizations and serves as a liaison to internally resolve complex issues. Develops strong interpersonal relationships with assigned providers.
  • Researches and resolves incoming escalated provider inquiries within contract guidelines. Educates providers on new protocols, policies, and procedures.
  • Assist with out of network single case agreement negotiations and maintain and distribute documents.
  • Maintains Quarterly network adequacy gap review.
  • Assist with physician recruitment by identifying specific providers within a designated territory, facilitating the distribution of provider agreements with focus on filling network adequacy gaps.
  • Ensure provider database and documentation is up-to-date, accurate and complete.
  • Process and maintain all provider excel grids.
  • Ensure new physician, group, hospital and ancillary contracts are entered promptly and accurately
  • Ensure credentialing documents are submitted for process and assist credentialing Vendor organization with follow up with providers on any missing documents.
  • Provider Directory review for accuracy.
  • Assists in scheduling provider meetings as needed.
  • Special projects as assigned or directed.

Qualifications:

  • At least 2-3 years of experience in a health care and/or managed care environment, claims experience preferred
  • Excellent written and verbal communication skills
  • Informational knowledge of health plan software systems.
  • Values sharing information (Be a teacher seek a teacher), honesty and integrity in everyday interactions
  • Ability to effectively manage multiple priorities
  • Excellent written and verbal communication skills
  • Ability to prepare and present formal presentations
  • Strong effective interpersonal skills
  • Ability to analyze data and track and trend variance from goals
  • Expert computer skills in Microsoft office i.e. Excel