Job purpose

The Provider Network Relations Development Specialist is responsible for maintaining successful working relationships between 8-koi and network providers, through a full range of provider relations interactions to ensure provider retention. Identify and remediate operational short-falls, respond to provider questions, and research and resolve accounts payable issues. Routinely negotiate cost effective fees for services, confirm service capability and educate providers on contract expectations, processes and paperwork. Comprehend detailed knowledge of customer requirements to translate subcontractor agreements, contractual requirements and fee agreements to the network facilities and/or providers. Provider Relations Specialists must be able to routinely evaluate and analyze the most beneficial solution for 8-koi, 8-koi clients, and our network providers in a variety of circumstances. Strong documentation, interpretation, and follow-up are essential activities of this position. Reports to the Provider Network Development Assistant Manager.

Duties and responsibilities

• After thorough research, professionally interacts and recruits potential medical facilities and clinics in support of the medical examination line of business through the building and maintenance of relationships with providers and office staffs, with a moderate need for direction.
• Assesses and resolves specific facility and/or provider concerns, developing and implementing solutions that are mutually beneficial to the facility and/or providers, CHS clients, and CHS.
• Understand and negotiates exam component fees that align provider needs and CHS business objectives.
• Educate providers to ensure understanding of CHS services and the fees associated with them. Provide guidance and/or education to provider network staff on component and/or client specific protocol.
• Proactively reviews and maintains provider compliance documents.
• Reviews, researches, and responds to provider network quality requests submitted through the Provider Information Network System (PINS) ticketing system. Collaborates with program management and medical staff as necessary.
• Ensure ongoing provider network data accuracy through regular reconciliation of the Provider Information Network System (PINS).

Other Requirements

• May participate in interdepartmental project groups or task forces to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specific level of knowledge pertaining to new developments, new task efforts, contract awards, and new policy requirements. Supports marketing/sales objectives and efforts as requested.
• Performs duties in a safe manner. Follows the corporate safety policy. Participates and supports safety meetings, training and goals. Ensures safe operating conditions within area of responsibility. Encourages co-workers to work safely. Identifies “close calls” and/or safety concerns to supervisory personnel. Maintains a clean and orderly work area.
• Assists in active implementation of company initiatives to ensure compliance with OSHA VPP, ISO, JCAHO, AAAHC, NRCME (DOT) and other mandated regulations/standards.

Qualifications

• High School diploma with 2 years relevant experience (provider relations, network management, customer service, quality assurance and/or negotiations).
• Associates degree preferred.
• Medical, dental, or healthcare network and/or insurance experience preferred. Proficiency with computer and common office equipment, as well as with MS Office products required.
• Must have excellent oral and written communication skills and strong analytical and problem-solving skills.

Working conditions

Working conditions are within a normal office environment.

Physical requirements

Normal office environment mobility; sitting, walking, bending, stooping, standing, lifting a maximum of 25 pounds (greater than 25 pounds requires a two-person lift), turning, pushing. Normal office dexterity, to include; reaching, handling, grasping, to include typing/keyboard, and phone use.