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Posted : Wednesday, August 21, 2024 11:23 PM
Department: HA - Prov Rel & Data Integrity
Entity: Health Alliance
Job Category: Professional
Employment Type: Full - Time
Job ID: 36741
Experience Required: 3 - 5 Years
Education Required: Not Indicated
Shift: Day
Location: Champaign, IL
Usual Schedule: M-F 8-5 PST
On Call Requirements: No
Work Location: Carle at The Fields
Weekend Requirements: No
Holiday Requirements: No
Position Summary:
Position is scheduled based on Pacific Time, 8-5p PST.
Serves as the face of Health Alliance to our provider community.
Responsible for being the point of contact between our providers and Health Alliance.
Triaging all provider issues to ensure that the issues are completed by the correct Health Alliance operational department on a timely basis.
Builds relationships with providers and their staff by meeting face to face and to ensure open communication.
Responsible for orientation of new providers and staff along with ongoing education and issue resolution.
Manage their area's provider demographic information as it pertains to network adequacy and accuracy of the provider directory.
Qualifications: EDUCATIONAL REQUIREMENTS Associate's Degree or Experience in Lieu of Education - CERTIFICATION & LICENSURE REQUIREMENTS Driver's License upon hire and Proof of Auto Insurance upon hire.
EXPERIENCE REQUIREMENTS Three (3) years of experience in Health Insurance or Health System Provider Network ManagementTwo (2) years General- Customer Service SKILLS AND KNOWLEDGE Computer skills with PC software, especially Microsoft Office products.
Must be able to project a professional, pleasant image while interacting with a variety of personalities.
Must demonstrate tact and diplomacy in interpersonal interactions, in addition to maintaining composure in confrontational situations.
Excellent listening, interpersonal, written and oral communication skills.
Demonstrates ability to communicate in a logical and efficient manner, with keen attention to detail.
Demonstrates excellent organizational and time management skills.
Knowledge of health insurance and health care system terminology.
Ability to plan and prioritize to achieve goals.
Must be able to understand and explain policies and operational procedures of the organization.
Essential Functions: Meets/Works with providers and their office staff and Health Alliance staff to explain policies and procedures and to resolve operational issues.
Follows up with written documentation and explanation to appropriate internal staff and providers as needed for provider/member complaints and other issues that may arise.
Attends Health Alliance/Partner Steering/Operations Meetings as needed.
Responsible for identifying educational needs within the provider network and ensures appropriate training programs and materials are provided.
This includes in services on claims submission, billing, reimbursement, referrals, authorizations, website, etc.
Communicates and provides written information regarding new products and new groups.
Writes and distributes inforMED newsletters.
Works with key providers and/or risk partners in maintaining an adequate provider network by notifying of network inadequacies in their assigned territories and working to resolve identified gaps.
Responsible for proofing and updating provider directories for assigned territories.
Acts as the point person for provider demographic, contract and system changes.
Develops, reviews, updates and maintains the provider manual.
Assists in the development of operational policies and procedures related to providers.
Provide documentation of the specific terminology used in key executed contracts and ability to understand and ensure compliance with the contract language and limitations.
Responsible for maintaining and updating PRS tracking system on a daily basis.
Exhibit commitment to continuous improvement through self-development and improvement.
Adheres to and enforces Health Alliance Medical Plans and Carle administrative and departmental policy and procedures.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.
| For more information: human.
resources@carle.
com.
Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members.
Requests for medical or religious exemption will be permitted.
Serves as the face of Health Alliance to our provider community.
Responsible for being the point of contact between our providers and Health Alliance.
Triaging all provider issues to ensure that the issues are completed by the correct Health Alliance operational department on a timely basis.
Builds relationships with providers and their staff by meeting face to face and to ensure open communication.
Responsible for orientation of new providers and staff along with ongoing education and issue resolution.
Manage their area's provider demographic information as it pertains to network adequacy and accuracy of the provider directory.
Qualifications: EDUCATIONAL REQUIREMENTS Associate's Degree or Experience in Lieu of Education - CERTIFICATION & LICENSURE REQUIREMENTS Driver's License upon hire and Proof of Auto Insurance upon hire.
EXPERIENCE REQUIREMENTS Three (3) years of experience in Health Insurance or Health System Provider Network ManagementTwo (2) years General- Customer Service SKILLS AND KNOWLEDGE Computer skills with PC software, especially Microsoft Office products.
Must be able to project a professional, pleasant image while interacting with a variety of personalities.
Must demonstrate tact and diplomacy in interpersonal interactions, in addition to maintaining composure in confrontational situations.
Excellent listening, interpersonal, written and oral communication skills.
Demonstrates ability to communicate in a logical and efficient manner, with keen attention to detail.
Demonstrates excellent organizational and time management skills.
Knowledge of health insurance and health care system terminology.
Ability to plan and prioritize to achieve goals.
Must be able to understand and explain policies and operational procedures of the organization.
Essential Functions: Meets/Works with providers and their office staff and Health Alliance staff to explain policies and procedures and to resolve operational issues.
Follows up with written documentation and explanation to appropriate internal staff and providers as needed for provider/member complaints and other issues that may arise.
Attends Health Alliance/Partner Steering/Operations Meetings as needed.
Responsible for identifying educational needs within the provider network and ensures appropriate training programs and materials are provided.
This includes in services on claims submission, billing, reimbursement, referrals, authorizations, website, etc.
Communicates and provides written information regarding new products and new groups.
Writes and distributes inforMED newsletters.
Works with key providers and/or risk partners in maintaining an adequate provider network by notifying of network inadequacies in their assigned territories and working to resolve identified gaps.
Responsible for proofing and updating provider directories for assigned territories.
Acts as the point person for provider demographic, contract and system changes.
Develops, reviews, updates and maintains the provider manual.
Assists in the development of operational policies and procedures related to providers.
Provide documentation of the specific terminology used in key executed contracts and ability to understand and ensure compliance with the contract language and limitations.
Responsible for maintaining and updating PRS tracking system on a daily basis.
Exhibit commitment to continuous improvement through self-development and improvement.
Adheres to and enforces Health Alliance Medical Plans and Carle administrative and departmental policy and procedures.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.
| For more information: human.
resources@carle.
com.
Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members.
Requests for medical or religious exemption will be permitted.
• Phone : NA
• Location : Champaign, IL
• Post ID: 9005008575
