Provider Relations Coordinators - FCC

Position Summary:


Our Provider Relations Coordinators are responsible for assisting healthcare providers and clients with resolving issues related to claims and provider participation questions. This role includes maintaining the provider database to ensure the Provider Directory and claim processing information is complete and accurate. May also assist with credentialing/re-credentialing activities and developing provider education material.

Qualifications:


EDUCATIONAL REQUIREMENTS
Bachelor's Degree in Related Field or Experience in Lieu of Education - Equivalent experience accepted in lieu of bachelors degree

CERTIFICATION & LICENSURE REQUIREMENTS
None specified

EXPERIENCE REQUIREMENTS
One (1) year experience in a managed care or health care environment

SKILLS AND KNOWLEDGE
To ensure success as a provider relations coordinator, you should be highly organized, have excellent communication skills and a strong working knowledge of Microsoft Office. A top-notch coordinator should provide excellent customer service, be able to work independently, and have the ability to multi-task in a fast-paced environment. Preferred skills include knowledge of physician coding and billing, claims processing, and credentialing procedures including federal and state regulations/guidelines. Ability to develop policies/procedures and monitor legislative requirements.

Essential Functions:

• Initiating and maintaining effective channels of communication with providers and clients.
• Establishing relationships with providers through office visits, telephone calls, prompt resolution of issues and excellent customer service.
• Gathering, reviewing, and verifying all pertinent information relating to participating providers.
• Develops communications, education materials, conducts and/or participates in education programs for providers and their staff.
• Maintain provider database to ensure accuracy and completeness of provider/group records.
• Oversees quarterly audit of Provider Directory.
• Prepares and distributes notifications to providers regarding credentialing/re-credentialing requirements and status.
• Oversees and audits provider contract information within claims system to assure correct processing of claims.
• Develops, reviews and maintains the provider manual.
• Participates in the development and implementation of policies and procedures related to provider relations, contract maintenance and credentialing that are compliant with all regulatory agencies.
• Assists in annual evaluation of provider network availability and accessibility standards and provider satisfaction surveys. Monitors provider satisfaction through written surveys and on-site visits.Participates on committees where expertise can be best utilized.
• Identifies needs of providers and their staff and coordinates with additional departments as necessary to provide appropriate support and initiate improvement opportunities.
• Participates in community activities representing FirstCarolinaCare.
• Prepares and submits reports as needed/required by FCC, Department of Insurance, and other regulatory agencies. Oversees the distribution of systems reports to providers.