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.
Perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as liaison between providers and the health plan to enhance the business relationship.
Conduct initial provider orientations as well as ongoing educational outreach
Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
Enhance account relationships by investigating, documenting and resolving provider matters and effectively handling and responding to account changes and correspondence.
Engage providers and educate them on Patient Centered Medical Home initiatives
Perform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and create reports for provider Review provider performance by both quantitative metrics and qualitative factors
Create and communicate milestone documents, dashboards and success or improvement metrics
Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance
Provide information and status updates for providers regarding incentive agreements
Conduct site visits when required
Perform other contracting duties as requested, including but not limited to recommending changes to pricing subsystems, submitting changes to provider related database information and assisting in the completion of special projects
Ability to travel
Bachelor’s degree in related field or equivalent experience.
2+ years of combined managed healthcare and provider reimbursement experience.
Advanced knowledge of Microsoft Excel.
Clinical or health information management (HIM) experience preferred.
Claims processing and/or managed care experience preferred.
Current state driver’s license.
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.
Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
Short- and long-term disability insurance
Basic Life insurance
Supplemental life insurance
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
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