Sr. Provider Relations Liaison - The Health Plan

 
Position: Sr. Provider Relations Liaison - The Health Plan

Job ID: 145248

Location: US-TX-Bellaire, US-TX-Houston

Department: PROVIDER RELATIONS SS/LTSS

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Mon - Fri

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are searching for a Senior Provider Relations Liaison – someone who works well in a fast-paced managed care setting. In this position, you will plan, direct and maintain strategies that assure harmonious relationships are established and maintained with physicians and other providers and efficient, effective care is delivered to membership within a discreet assigned territory. Educate providers through in service programs that review policies and procedures physicians are obligated to adhere to, discuss physician feedback as necessary and promote continuing education classes and other educational programs that support the goals and objectives of the health plan. Management of provider issues related to continuity of care, system configuration, contracting, authorization, billing, Service Coordinator complaints, Provider/Member complaints, and HHSC complaints whereby liquidated damages are potentially imposed. Also manages the most complex and challenging of claims issues specific to a new provider type and product line.

Think you’ve got what it takes?



Responsibilities :

Job Duties and Responsibilities

 

  • Develops and maintains strong business relationships with participating providers
  • Develops and follows territory strategic plan aligned to Texas Children’s Health Plan and Texas Children’s mission and vision
  • Creates Community and Provider Satisfaction
  • Supports Regulatory and Operational Compliance
  • Ensure timely completion of all team projects, assignments, and job duties


Qualifications:

Requirements

 

  • Bachelor’s Degree in Health Care, Business or related field
  • DL ANY - DRIVER'S LICENSE ANY STATE
  • Current personal motor vehicle insurance is required for all new hires/transfers
  • 4 years of health care or managed care experience


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