Provider relations rep

Job Summary

Under supervision of Director Provider Relations oversees workflow and coordination of Provider Relations projects that support Beaumont Health facilities & affiliated physicians with both Managed Care plans and the Employee Health Plan Provider Network. Assist Sr. Provider Relations Representatives as appropriate to complete implementation of key Managed Care & Beaumont Health Employee Health Plan related projects and communications both written and oral. Ensure tracking of key data provider data elements are accurate and kept current. Planning and organizational skills are extremely important in this position and must demonstrate a strong commitment with respect to exceeding customer expectations as well as resolving issues with a high level of tact and understanding. Must interact effectively as a team member and demonstrate a capacity for management of multiple projects and shifting deadlines.

Essential Functions

• Track and maintain provider data in Managed Care Contracting system software.
• Work with third party payers on behalf of providers to help facilitate the enrollment and participation process. Work with payers on roster generation and audits to ensure both parties have accurate current information on participating providers and required data elements.
• Educate and facilitate the process for providers to become an Oakwood ACO member. Track current Oakwood ACO membership in Managed Care Contracting system software.
• Work with providers to explain payer requirements for enrollment and process to become a participating provider including distribution of any provider material as needed. Communicate updates and changes of known payer processes that will impact providers.
• Assist with maintaining the Employee Health Plan Provider Network via routine reconciliations of contracted providers and communicating any needed changes with current Third Party Administrator (TPA).
• Assist in ensuring provider satisfaction through education and training problem resolution and provider relations activities.
• Identify issues and coordinate problem resolution for physicians hospitals and their support staff. Investigate and facilitate resolution of managed care related issues; involves complex and unusual issues requiring creative problem-solving skills.
• Assist with communication of critical information to providers including financial models contractual terms/ obligations and payer plan updates through bulletins newsletters and other media.
• Aid System Director and Sr. Provider Relations oversight and completion of special projects; performs all other duties as assigned.
• Aid Sr. Financial Analyst with special projects as needed.

Qualifications

Required

• Associates degree in business or related field.

• 1 year of relevant experience A minimum of one year experience in third-party provider enrollment.

About Corewell Health

As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement - to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

• Optional identity theft protection home and auto insurance pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

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Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.

An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.