Provider Relations Rep 1-Contracting

Baylor Scott & White Health

2d•$25 - $42

About The Position

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. The Provider Relations Representative 1 provides excellent customer service to providers. They give timely and accurate responses to all provider concerns and issues. They deliver adequate training and education to providers for all product lines. They support various operational management aspects of contracting and credentialing.

Requirements

Knowledge of managed care and/or health insurance industry.
Proven relationship management skills.
Able to negotiate and revise contracts in order to maximize cost effective care.
Proven problem-solving and data-based skills.
Able to collaborate on process definition and improvement and ensure quality standards are met.
Able to multi-task, set priorities, and work autonomously with minimal supervision.
Able to travel at least 75% of the time Monday through Friday, including some overnight stay.
Excellent written and verbal communication skills.
Bachelor's or 4 years of work experience above the minimum qualification
1 Year of Experience

Responsibilities

Develops and maintains trusting relationships with providers and their staff through visits, calls, and correspondence. Meets weekly provider contact goals and provides excellent customer service. Serves as the liaison for providers and responds to all concerns. Works with internal departments to ensure providers have a complete resolution.
Provides adequate education and training to providers and their office staff for all product lines. This includes conducting new provider orientations.
Assists the Credentialing Team by performing site visits or surveys as needed. Identifies gaps in the network. Works with the Network Development Team to find providers to fill the gaps.
Works with the Quality Improvement team on various HEDIS initiatives with the providers.
Facilitates information gathering for contract negotiations and reviews. This helps expand provider networks and maximize cost-effective care. Participates in financial negotiations of hospital contracts. Refers these negotiations to financial offices.
Conducts periodic reviews and revises existing contracts in order to maximize cost effective care. Proposes modifications to new contract language.
Collaborates with other departments to provide a systematic credentialing process for contracted providers. Ensures effective contracting based on cost and frequency of use. Ensures contracted providers and services meet quality standards for safe and effective patient care.