Provider Relations Coordinator - The Health Plan

 
Position: Provider Relations Coordinator - The Health Plan

Job ID: 149173

Location: US-TX-Bellaire

Department: PROVIDER RELATIONS RESPONSE

Talent Area: Clerical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a -5p Monday - Friday

About Texas Children's Hospital

Texas Children’s Health Plan (TCHP) is the largest Texas Medicaid managed care organization, and is part of the Texas Children’s healthcare system. Founded in 1996, TCHP is the nation's first health maintenance organization (HMO) created just for children and pregnant women. Our plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. Currently the Health Plan serves more than 450,000 members across three service areas (Harris, Jefferson, North East). Members of the plan receive care from our network of more than 4,000 primary care physicians, 8,000 specialists, and 110 hospitals. They can also receive care at The Center for Children and Women, a patient and family-centered medical home with two convenient locations for TCHP members who can have all their medical needs met in one place, receiving multiple services the same day. TCHP is a recognized leader at encouraging holistic care that empowers families to live healthier lives. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a Provider Relations Coordinator — someone who works well in a fast-paced setting. In this position, you'll serve as the front-line specialist in the handling of any escalated customer concerns and/or issues.

 

Think you’ve got what it takes?



Responsibilities :

·         Reviews systems to identify issues that may require significant time for research, collaboration with other departments, communications with external resources, and response creation

·         Functions as a primary business partner for Provider Relations Liaisons, specific to claims research, for the more complex provider issues

·         Manages specific system queues used by the department to correspond with other business segments regarding provider issues

·         Provides daily and monthly monitoring of escalated and potential claim issues for provider liaisons or manager

·         Identifies opportunities for process and service improvement initiatives

·         Participates in the development and implementation of action plans and/or projects as assigned

·         Resolves escalated concerns from providers and escalated issues to manager as needed for systemic improvements

·         Identifies and informs management of issues requiring escalation and the identification of system trends requiring interventions



Qualifications:

·         Bachelor’s degree required

·         3 years of experience in health care administration or managed care is required



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