Provider Relations Representative – The Health Plan

 
Position: Provider Relations Representative – The Health Plan

Location: US-TX-Bellaire

Talent Area: Administrative Support

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

The 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

Summary:

We are searching for a Provider Relations Representative — someone who works well in a fast-paced setting. In this role, you'll be responsible for developing and maintaining positive relationships internally within the department and externally with physicians, providers, and practice managers of the delivery system. This position is responsible for formal and informal training of participating providers and departmental staff. This role interacts with physicians, directors, managers, and peers daily and will manage/complete major project plans and allocations.

 

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

 

  • Develops, updates, and maintains written and online tools for provider education and support
  • Analyzes and validates provider information from multiple sources and audits provider changes to ensure changes are complete and accurate
  • Ensures appropriate and timely escalation of provider issues to management and provides resolutions to issues or questions using health plan provided procedures
  • Documents all communication with providers according to departmental requirements and collaborates with provider relations managers on territory-based issues and concerns or needs and opportunities
  • Prepares utilization reporting on the portal and researches and tracks non-claim related provider concerns
  • Responds to provider requests for information

 



Qualifications:

Skills & Requirements

 

  • High school diploma or GED
  • 5 years of health care administration, managed care, or customer service experience
  • Bachelor’s degree in business administration, health education, or a related field may substitute for 4 years of health care administration, managed care, or customer service experience


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