Responsible for performing all physician, hospital and ancillary provider orientation, training and ongoing educational activities for CCHP network providers and their staffs. Responsible for the tracking of concerns, complaints and issues raised by network providers, and results reporting. Facilitates resolution of all complaints/issues raised by network providers related to members, claims, operational policies and organizational procedures. Responsible for ensuring the accuracy and completeness of CCHP provider directory information. Coordination of the development and publication of the CCHP provider newsletter. Development & maintenance of the CCHP provider reference guide. Develops and implements additional communications required to assure that CCHP providers are knowledgeable regarding CCHP operations and programs.
High School graduate with advanced training in healthcare, business, or a related field required.
Five (5) years of operational experience in a managed care organization specifically in the area of provider network management to include provider orientation, ongoing educational activities, problem resolution and provider communications required. I
Incumbent must demonstrate proven success in establishing and maintaining positive working relationships with health care providers and their staffs.
Working knowledge of HMO business operations specifically the functions of utilization management, member services, claims, credentialing and benefit plan interpretation.
Experience preparing and presenting information to individuals and groups.
Must be attentive to detail, have excellent organizational, problem solving, verbal and written skills.
Must be able to work independently and actively participate as an integrated team member.
Experience with governmental managed care programs desired