Provider Performance Representative
Position Purpose: The Provider Performance Representative has daily interaction with internal departments, as well as the external Provider Network. This position requires initiative and excellent customer service focus when dealing with provider issues and concerns, as well as being able to use sound and objective decision-making in all interactions with providers and internal departments, with excellent verbal and written communication skills. This position requires knowledge of all elements of Steward plans, processes, and policies, in addition to AHCCCS, CMS, and HealthCare Exchange plans, to assist with education of the providers.
- Provide face-to-face, written and telephone communication to providers, in order to identify, discuss and resolve various issues, following Network guidelines and in a timely fashion.
- Disseminate/communicate information to internal colleagues and appropriate departments regarding provider issues and concerns.
- Ensure providers are following proper medical procedure and referral information/authorization, covered service guidelines, submission of claims, credentialing guidelines, and proper policies and procedures for all lines of business.
- Maintain and ensure provider demographic information is complete and up-to-date.
- Assist in developing written materials to assist providers in following Steward procedures.
- Coordinate with Network Leadership and physicians/providers in an assigned territory area, to ensure adequate medical services for all members.
Education / Experience / Other Requirements
- College Degree preferred.
Years of Experience:
- At least two (2) years, with excellent customer service experience or claims experience, with a managed healthcare plan. Experience in the Behavioral Health field is a plus, but not required.