Provider Relations Representative

Profile

Description

Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole.

Responsibilities

The Provider Relations Representative develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Relations Representative work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Provider Relations Representative represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. We're seeking someone who is personable, with excellent written, verbal and communication skills. Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Center Address: Conviva Care Center Central Corpus, 917 S Port Ave, Corpus Christi, TX 78405

Job Functions


Supports, develops and maintains service relationships with all participants (physicians, providers and administrators) of a provider network.
Responds to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing, etc.
Provide guidance or expertise to less experienced representatives.
Serves as the primary liaison between the organization and health care providers, such as medical doctors and dentists.
Answer questions from doctor's offices about benefit verification
Enter claims data for processing, and maintaining a good relationship with providers.
Specific job duties may vary.


Required Qualifications


Bachelor's Degree
1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience.
50% travel within described market within the state of Texas.
Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies.
Demonstrated ability to manage multiple projects and meet deadlines.


Preferred Qualifications


Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance.
Comprehensive knowledge of Medicare policies, processes and procedures.


Alert

Conviva, a subsidiary of Humana, values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from **** with instructions to add the information into the application at Humana's secure website.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview. In this interview, you will receive a set of interview questions over your phone and you will provide recorded or text message responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Benefits

Being a part of the Conviva team gives you: We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k, tuition reimbursement, vacation, paid holidays, work-life balance, growth, a positive and fun culture and much more.

Scheduled Weekly Hours

40

Company info

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