Sr. Provider Relations Rep
Houston, Texas
Employer: Harris Health System
Industry: Provider Relations
Salary: Competitive
Job type: Full-Time
About Us
Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health’s robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet® nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); The University of Texas MD Anderson Cancer Center; and the Tilman J. Fertitta Family College of Medicine at the University of Houston.
Job Profile
JOB SUMMARY: The Senior Provider Relations Representative is office-based and is responsible for resolving Physician, Hospital, Ancillary, and Physician organization (Provider) focused issues including, but not limited to educational needs, contract verification, participation status, claims payment discrepancies, interaction with Community's provider portal, and questions regarding Community's process for obtaining authorizations. The Senior Provider Relations Representative exhibits good communication and interpersonal skills; maintains a working knowledge of the designated QNXT referral, claims, eligibility, and provider modules, as well as all CACTUS modules, and serves as the primary party responsible for responding to inquiries referred to Provider Relations. The Senior Provider Relations Representative ensures that new Providers receive the required initial education materials, i.e., Provider Manual, Quick Reference Guides, etc.; supports the Provider Engagement Representatives and Provider Relations Representatives by monitoring and reporting educational needs identified through web inquiries, reports, and other analytical measures; may provide guidance or expertise to fellow team members. Works closely with management or takes the lead to create, maintain and update provider communications including, but not limited to provider notices, provider manuals, quick reference guides, and orientations as required by URAC, NCQA, TDI, HHSC, CMS, and other regulatory agencies. Collaborates with leadership, co-workers, and staff in other departments to achieve departmental and organizational objectives.
MINIMUM QUALIFICATIONS:
1. Education/Specialized Training/Licensure: High School or equivalent required. BA/BS in Business preferred
2. Work Experience (Years and Area): 5 years' experience in managed care (Provider Relations/Services; Claims Adjudication, Medical Coding, Contracting)
3. Software Operated: Microsoft Office (Word, Excel, Outlook and PowerPoint), QNXT and CACTUS systems preferred
SPECIAL REQUIREMENTS: (Check Applicable Areas)
1. Communication Skills: Above Average Verbal (Heavy Public Contact)
Writing /Composing: Correspondence / Reports
2. Other Skills: Medical Terminology, Statistical, MS Word, MS Excel, MS PowerPoint
Work Schedule: Flexible
RESPONSIBLE TO: Director
Benefits and EEOC
Harris Health System's benefits program is designed to provide you with more flexibility and choices in meeting your specific needs. Harris Health System's benefits program allows you to protect your income in case of illness, death and disability, and to help you save for retirement.
It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless of political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process.
Job Category
Community Health Choice (CHC)
Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health’s robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet® nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); The University of Texas MD Anderson Cancer Center; and the Tilman J. Fertitta Family College of Medicine at the University of Houston.
Job Profile
JOB SUMMARY: The Senior Provider Relations Representative is office-based and is responsible for resolving Physician, Hospital, Ancillary, and Physician organization (Provider) focused issues including, but not limited to educational needs, contract verification, participation status, claims payment discrepancies, interaction with Community's provider portal, and questions regarding Community's process for obtaining authorizations. The Senior Provider Relations Representative exhibits good communication and interpersonal skills; maintains a working knowledge of the designated QNXT referral, claims, eligibility, and provider modules, as well as all CACTUS modules, and serves as the primary party responsible for responding to inquiries referred to Provider Relations. The Senior Provider Relations Representative ensures that new Providers receive the required initial education materials, i.e., Provider Manual, Quick Reference Guides, etc.; supports the Provider Engagement Representatives and Provider Relations Representatives by monitoring and reporting educational needs identified through web inquiries, reports, and other analytical measures; may provide guidance or expertise to fellow team members. Works closely with management or takes the lead to create, maintain and update provider communications including, but not limited to provider notices, provider manuals, quick reference guides, and orientations as required by URAC, NCQA, TDI, HHSC, CMS, and other regulatory agencies. Collaborates with leadership, co-workers, and staff in other departments to achieve departmental and organizational objectives.
MINIMUM QUALIFICATIONS:
1. Education/Specialized Training/Licensure: High School or equivalent required. BA/BS in Business preferred
2. Work Experience (Years and Area): 5 years' experience in managed care (Provider Relations/Services; Claims Adjudication, Medical Coding, Contracting)
3. Software Operated: Microsoft Office (Word, Excel, Outlook and PowerPoint), QNXT and CACTUS systems preferred
SPECIAL REQUIREMENTS: (Check Applicable Areas)
1. Communication Skills: Above Average Verbal (Heavy Public Contact)
Writing /Composing: Correspondence / Reports
2. Other Skills: Medical Terminology, Statistical, MS Word, MS Excel, MS PowerPoint
Work Schedule: Flexible
RESPONSIBLE TO: Director
Benefits and EEOC
Harris Health System's benefits program is designed to provide you with more flexibility and choices in meeting your specific needs. Harris Health System's benefits program allows you to protect your income in case of illness, death and disability, and to help you save for retirement.
It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless of political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process.
Job Category
Community Health Choice (CHC)
Created: 2024-08-22
Reference: 172639
Country: United States
State: Texas
City: Houston
ZIP: 77069