Job: Provider Relations Rep - Job #: 69467

Location: US-CO-Greeley
Posted Date: 10/2/2009
Shift: Day
Category: Business Professional (Non-Clinical) - Positions
Department: Managed Care
Facility: Managed Care - Colorado Region
Position Type: Part-Time-PA
Shift Hours: Varied Day
Hours Per Week: 20

Overview:
Majority of time is spent traveling to physicians' offices Colorado, Wyoming and Nebraska conducting site visits, educating the office staff, recruiting new offices, and resolving established problems. Provide education to physicians and their office staff. This includes, but is not limited to coordinating orientation and education of providers, hospitals and Western Region managed care staff. Identify and resolve managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues. Maintain all levels of communication with network providers, informing them of any operational, procedural, and contractual changes and updates. Assist internal departments in resolving provider and member appeals pertaining to Western Region managed care contracts. Assist Provider Relations Manager with network development in various geographic regions within Banner Health, negotiate, implement and maintain managed care contracts with payers and providers.

Pay opportunity $18.22 - 29.09.
Responsibilities:

Prefer bachelor's degree in business, healthcare administration, or related field however will consider 4 years of strong experience in a similiar managed care position. Knowledge and experience with the resolution of managed care issues, contract interpretation and utilization management. Proven experience in data retrival and statistical analaysis. Experience with provider and member appeals. Understanding of coding and how it relates to billing issues and resolutions.

PREFERRED QUALIFICATIONS
Three years of experience in the healthcare field preferred. Two years of medical claims auditing experience is preferable.