Consultant

• Provide quality, accessible and comprehensive service to the company's provider community; Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and/or face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues.
• Collaborates with internal matrix partners to triage issues and submit work request
• Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners
• Coordinates communication process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns
• Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a variety of initiatives and programs
• Coordinates and conducts provider training including developing and distributing provider relations materials.
• May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues
• May coordinate Provider Manual updates/maintenance
• Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery
• Research issues that may impact future provider contract negotiations or jeopardize network retention

Provider Relationship Account Consultant

Job Level

About the role

Requirements

Account Consultant – Provider Relationships

Account Consultant, Provider Relations

Compliance and Quality Assurance Specialist

Customer Service Advisor

Customer Experience Associate, Retention Representative