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Senior Provider Relations Representative

Community First Health Plans
Category | Professional Non-Nursing Job Schedule | Full Time Job Shift | Day Shift Job ID | 00009377 Post Date | May. 19, 2024 Department | Network Management
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POSITION SUMMARY/RESPONSIBILITIES
Working with Department management, evaluates, plans, develops and maintains HMO network of primary care physicians/groups including RHCs, FQHCs,PHOs, IPAs and/or multi-site primary care groups, specialist physicians (individuals and groups) and ancillary services providers for health plan services. Acts as a liaison to assigned providers to ensure that all of the groups are effectively informed and updated by the health plan as necessary. Demonstrates an ability to develop and manage the relationship with large and complex provider groups including IPAs and PHOs. Effectively manages individual providers requiring focused attention. Resolves complex issues effecting provider relations.

EDUCATION/EXPERIENCE
A Bachelor's degree in health care administration, business or a related area is required. Five years of progressively increasing responsibility and experience in managed care environment may be substituted for the Bachelor's degree. A minimum of three years of recent experience as a provider relations representative, member service representative or relevant claim experience is preferred.

LICENSURE
Valid Texas drivers' license and a reliable vehicle are required.

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