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Provider Relations Representative - (203884)

Universal Health Services


Date:
12/12/2017
2017-12-122018-01-10
Job Code:
989
Universal Health Services
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Job Details

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Job Details


Provider Relations Representative - (203884)

Facility Name
Prominence Health Plan
Location
AMARILLO, TX 79106 US (Primary)
Career Area
Professional
Category
Other
Job Description

Founded in 1978, Universal Health Services, Inc. (UHS)* is one of the nation’s largest and most respected healthcare management companies, operating through its subsidiaries—acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHS’s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHS’s well-reputed franchise with its customary exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortune’s Most Admired Companies. UHS’s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care.

Prominence Health Plan was established in Reno, Nevada in 1993 as a Health Maintenance Organization (HMO) and was originally known as St. Mary’s Health Plans. In 2014, a subsidiary of Universal Health Services, Inc. (UHS) acquired the company and renamed it Prominence Health Plan. In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator. In addition, Prominence Health Plan owns the Preferred Health Care Network (PHCN), a local provider network. Prominence Health Plan’s HealthFirst HMO/POS is accredited by the National Committee for Quality Assurance (NCQA), which involves a rigorous review of Prominence Health Plan consumer protection and quality improvement systems. Prominence Health Plan’s access to network providers includes 34 hospital and over 3,500 providers statewide, in addition to providers outside of Nevada through network lease arrangements.

Job Summary: The Provider Relations Representative serves as the liaison between Prominence Health Plan and its contracted providers. Is responsible for maintaining strong relationships with providers and routinely communicates organizational policies, procedures and processes. Focuses on proactive and timely problem resolution of both organizational and provider-based issues. Responds to educational needs of providers and their office staff in any matters concerning provider relationships with Prominence Health Plan and network service issues. Facilitates the development of a comprehensive provider network and serves as the primary contact, offering education, technical assistance and problem-solving as necessary.

Job Requirements

Regulatory Requirements:

 

  • High School Graduate/Equivalent.   Knowledge of provider reimbursement, Medicare reimbursement, coding and Hedis Measures and care gap reporting preferred.
  • Knowledge of Medicare Advantage and ACA risk scores and ability to educate providers and key levers to further enable the health plan’s success

     

  • Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff

     

  • Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.)

     

  • Understanding of health plan departments and functional areas for problem resolution

     

  • Experience in customer service/relations-like roles

     

 

 

Language Skills:

 

  • Ability to effectively communicate in English, both verbally and in writing.

     

Skills:

 

  • Proficient in Microsoft Office skills (Excel, Word, Access,etc.) 

     

  • Enjoys working in both individual and team settings

     

  • Problem solver – enjoys problem-solving 

     

  • Self-starter, resourceful and able to execute projects in a fluid and fast-paced environment

     

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