logo

View all jobs

Provider Relations Specialist I - Iowa City

Iowa City, IA · Healthcare
About the Company: 
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals.  Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).  

The Company operates local health plans and offers a range of health insurance solutions.  It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.


Position Overview:
This position will travel the Iowa City and surrounding counties area.

Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices.


Responsibilities:
  • Serve as primary contact for providers serving as a liaison between the provider and the health plan
  • Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on
  • site and routing to the appropriate party for resolution
  • Receive and respond to external provider related issues
  • Initiate entry or change of provider related database information and oversee testing and completion of change request
  • Investigate, resolve and communicate provider claim issues and changes
  • Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving
  • Perform provider orientations, including writing and updating orientation materials
  • Ability to travel


Qualifications:
Education/Experience:
  • High school diploma or equivalent. Bachelor’s degree in healthcare related field preferred.
  • 3+ years of sales, provider relations, or contracting experience.
  • Knowledge of health care, managed care, Medicare or Medicaid.
  • Claims billing/coding knowledge preferred.
  • Driver’s License may be required by some plans.
  • Specific language skills may be required by some plans.

License/Certification: Valid driver's license.

 
Benefits: 
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions. 
  • Health insurance
  • Dental insurance
  • Vision insurance
  • Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
  • Short- and long-term disability insurance
  • Basic Life insurance
  • Supplemental AD&D
  • Supplemental life insurance
  • Wellness Program
  • 401(k) retirement with company match
  • Employee stock purchase plan
  • Vacation, Personal and Sick time
  • Paid Company Holidays
  • Employee Assistance Program (EAP)
  • Training and Learning Opportunities
  • Tuition Reimbursement/Educational Assistance
  • Service Awards
  • On-site fitness center or discount at local fitness centers (most locations)
  • Discounts for select local and national products and services, including cell phones, computers and more
  • Other amenities may be available, but vary by location
April A. Estes
ProEnlist, LLC
Connect with me on LinkedIn
For More Jobs: 
ProEnlist on Linkedin
ProEnlist on Facebook
ProEnlist on Glassdoor

Please do NOT email the recruiter.  Applications are only accepted via the apply link.
C2C Not Available for This Position




 
Powered by