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Provider Relations Representative

2507 Delaney Ave
Wilmington, NC
Job ID: 11704
Date Posted: Nov 5, 2022

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Job Description

Description

About NHRMC

NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health. We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians. With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice. Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.

About the Job

Location: New Hanover Health

Department: New Hanover Health

Full Time Equivalent: FTE: 1.000000

Work Type: 64 to 80 Hours Pay Period

Work Schedule: STD HRS - Standard-Exe or Office w flex

Exempt from Overtime: Exempt: Yes

What You'll Do

Summary:

The Provider Relations Manager helps support strategic growth for New Hanover Health in alignment with the corporate strategic plan. The Provider Relations Manager proactively identifies opportunities and demonstrates ability to lead successful improvement initiatives. Under the direction of the Director of Network Operations, he/she will develop and implement plans of action for determining and achieving provider satisfaction, provider retention and growth within New Hanover Health through open dialogue, new provider on-boarding and in-person visits with both affiliated and non-affiliated providers in the assigned service areas. Provides leadership for New Hanover Health in the following areas: Health Risk Assessment (HRA) completion, HCC Risk coding, HEDIS Star measures, provider retention, clinical services marketing, communications, access management, issues management and provider relations.


Responsibilities:

Cultivate and maintain collaborative relationships with network providers. Tasks include orientation, training, and working with providers and staff to problem solve day-to-day issues and identify barriers. Act as the liaison between the health plan and providers to ensure the ongoing management and improvement in HRA completion, HCC Risk Coding and HEDIS Star Measures Introduce and familiarize providers on all aspects of the provider manual related to services, benefits and provider requirements; care coordination and authorization protocols; claims filing; and the web portal; Collaborate with network development to identify gaps in the network and access issues. Resolve network provider inquires timely through email, and provider visits. Monitor and trend provider issues documented through workflow, calls, emails, and other avenues Perform duties to act as a liaison between providers, the health plan and corporate including investigating and resolving provider claims issues. Serve as primary contact for providers serving as a liaison between the provider and the health plan Conduct joint operating committee meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site and routing to the appropriate party for resolution • Initiate entry or change of provider related database information Investigate and communicate provider changes

Position Requirements

Credentials:

Education:
* Bachelors Degree

Other information:

 Bachelor’s degree in nursing, business, healthcare administration, marketing, communications, management and leadership or a related field required, and more than three years of progressive experience in healthcare marketing, provider relationship management, provisions clinical services, sales or a related discipline. · Demonstrates excellence in leadership, communication, customer service, planning, performance improvement, analytical and collaboration skills. Utilizes data management skills, demonstrates the ability to organize and prioritize workload. Works with a variety of individuals. Knowledge of local healthcare marketplace. Performs independently with minimal supervision. · Proficient in Microsoft Office Suite products – Word, Excel, PowerPoint. Must possess reliable transportation due to frequent travel

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