Lead Provider Relations Specialist

Job Description

Position Purpose:Coordinate the operations of the provider relations department. Monitor and perform departmental day to day duties to assure that provider information is accurate for state reporting, claims payment and directories.

• Coordinate resolution of escalated issues generated from key stakeholders within an assigned service areas, including partnering with operational leadership.
• Handle all aspects of claims research and take escalated calls.
  
• Act as primary liaison between providers, health plans and corporate, including investigating and resolving provider issues.
  
• Lead contracting and credentialing efforts in assigned territory where expansion may be required, in addition to states located in new markets.
  
• Monitor and analyze costs and prepare departmental budget related to trade-shows and events.
  
• Plan, coordinate and develop education activities for provider in assigned states and new markets, including webinars, educational materials and in-person training sessions.
  
• Assist with the development of training materials and onboarding program for newly hired staff.
  
• Provide day-to-day workflow support of the provider relations function in compliance with health plan, corporate and state policies, procedures and guidelines.
  
• Lead and assist with HEDIS quality improvement activities with provider representatives and health Plans in assigned markets.