Maryland Physicians Care · 18 hours ago
Provider Relations Representative
Linthicum,MD,US
Full-time
Onsite
Mid Level
3+ years expMaryland Physicians Care is a healthcare organization managing a statewide provider network. The Provider Relations Representative is responsible for addressing provider issues, providing support to internal departments, and conducting provider training and audits.
Insurance
Responsibilities
Develops and maintains positive provider relationships to assist in provider network maintenance and growth
Responds timely to incoming provider calls, serving as the primary provider liaison
Serves as knowledge and resource expert regarding resolution of provider issues
Trains providers regarding MPC systems, processes, and benefits; conduct follow-up training to ensure policy compliance and education continuity; disseminates written correspondence as necessary to address issues, problems, and new information, as needed
Researches provider disputes related to claims and member issues
Responds to provider correspondence in a thorough and timely manner
Tracks and responds to provider grievances and appeals
Conducts provider site visits/audits
Monitors provider availability and accessibility, including coverage and response time to service requests
Assists with onsite contractual reviews; ensures 100% accuracy and timeliness of information/modification data entry in provider files
Provides training in user specific areas of referral network and procedures, pre-authorization, coding, (ICD-9, HCPC, CPT-4) and billing (CMS 1500, UB04)
Maintain effective working relationships with various providers, networks, and managed health care components
Continue education regarding changes and trends in health care management and specific provider communities
Qualification
Required
Knowledge of provider relations
Strong problem-solving skills
Ability to present information effectively in one-on-one and small group settings to providers and employees
Ability to be a positive team player able to manage project time constraints and work with little supervision
Ability to successfully utilize business application software, Microsoft Office suite and common computer and office hardware
Experience with physician providers, medical terminology, common coding, and billing requirements is required
Demonstrated experience with claims processing and research required
Must possess reliable transportation with proper insurance coverage and be available for travel both in and out of state
Preferred
Bachelor's degree in business, health, management systems or related discipline preferred with a minimum of three (3) years' experience with provider relations
Benefits
Medical, dental, and vision plans
100% employer Term Life Insurance
Short and Long-Term Disability
401k Employer Match up to 4%
20 days of PTO
Tuition assistance/professional development plans
Company
Maryland Physicians Care
Maryland Physicians Care (MPC) is a local managed care organization owned by Ascension Saint Agnes, Holy Cross Health, Meritus Health, and UPMC Western Maryland.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Jason Rottman
President and CEO
Chuck Buseck
Chief Operating Officer
Company data provided by crunchbase