Provider Relations Representative - The Health Plan

 
Position: Provider Relations Representative - The Health Plan

Job ID: 157853

Location: US-TX-Bellaire

Department: PROVIDER RELATIONS RESPONSE

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

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 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.  

Summary:

We are searching for a Provider Relations Representative -- someone who works well in a fast-paced setting. In this position, you will be responsible for developing and maintaining positive relationships internally within department and externally with physicians, providers, and practice managers within delivery system. This position is responsible for formal and informal training of participating providers and department staff. This position is also responsible for managing and completing major departmental projects including recommending project plans & recommending resource allocations.

 

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

  • Research, develop, and implement a coordinated approach to provider inquiries
  • Prioritize inquiries based on provider need, organizational impact and risk
  • Review updates from the state pertaining to provider data to ensure we remain compliant
  • Audits high-impact provider additions to the network, terminations from the network and changes to ensure updates are complete and accurate
  • Collaborate with contracting and other departments as needed to ensure provider inquiries are responded to by the appropriate subject matter expert in a timely manner
  • Prepares regulatory reports on provider data including network capacity and provider terminations
  • Incorporates data and reports from vendors including pharmacy and vision data
  • Participate in improvement projects, programs and initiatives to support the mission and strategic imperatives of the organization


Qualifications:

Skills & Requirements

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


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