About Texas Children's HospitalThe Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health. Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women. We are an Integrated Community System providing holistic care that empowers families to live healthier lives. Texas Children's Health 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 state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. 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
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?
Job Duties and Responsibilities
***THIS POSITION IS IN THE NORTHEAST SERVICE AREA, AND WILL BE BASED OUT OF THE TYLER, TX OFFICE. CANDIDATES MUST RESIDE IN NORTHEAST SERVICE AREA FOR CONSIDERATION***