Service Specialist - Provider Relations & Network Management
Bloomington, MN 
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Posted 10 days ago
Job Description

Job Description:

We currently have an exciting opportunity for Service Specialist to work with our Provider Relations and Contracting Group. This position is the key resource to assigned primary care medical groups, specialty providers, hospitals and/or other providers ("providers"). To maximize the efficiencies and quality of our provider relationships, this position will act as a facilitator to resolve provider concerns and questions and will assist provider staff in understanding and implementing new and existing HPI products, policies, procedures and systems. This position plays a key role in contract support through fee schedule and contract implementation. At HealthPartners, you'll find a culture where we live our values of excellence, compassion, integrity and partnership. By working together, we will improve health and well-being, create exceptional experiences for those we serve and make care and coverage more affordable.

Accountabilities: * Provide pro-active and on-going communication and education to designated providers' staff regarding HPI products, policies, procedures, and systems. This is done through regularly scheduled meetings, ad hoc meetings, phone calls, seminars, and educational in-services arranged and/or presented by the HealthPartners staff. Providers' staff is defined as business office personnel, receptionists, training staff, referral management staff, physicians, other medical staff, clinic managers, and administrators.

* Review with the provider their current systems to determine if there is a need to set up new processes to effectively implement or operationalize new HPI products, policies, and procedures, taking into consideration the providers' individual specifications, limitations, and corporate structure. Service Specialist provides suggestions to the provider on how it can design a new process/system so that compatibility exists with the operation. Service Specialist consults with both the department manager and with supervisors/managers in other internal departments to ensure a new provider groups' operation will be compatible with HPI operations.

* Prepare in written form and distribute to "Provider Alert" recipients individual clinic variation information, changes, and update information to HPI staff so that internal operations reflect the most current provider status. This includes, but is not limited to, physician data, provider operations data, product participation, provider access and claims submission and processing nuances.

* Prepare and coordinate the creation of legal contract documents and ensure the successful implementation of contracts in accordance with the Minnesota Department of Health, government programs, accreditation, and other regulatory agency requirements.

* Collaborate and problem solve with internal HPI departments (Claims, Medical Services, Member Services, Membership Accounting, Accounts Payable, Clinic Operations, Support Services, Quality Utilization Management, Referral Secretaries, Government Service, Pharmacy Care Network, Other Contracting Departments and Sales and Marketing) to improve administrative efficiencies that will allow the providers to successfully deliver care to HPI members, to improve contracting opportunities for cost savings and/or to improve administrative interfaces.

* Serve as the department expert for his/her provider in the areas of billing, coding, market reimbursement and utilization review.

* Identify and implement solutions to issues and problems identified by provider groups related to HPI administration, products and programs.

* Participate in contract negotiation meetings, identifying administrative requirements necessary for Provider Agreements.

* Assist in the development of additional provider management reports identified through the participation of the Medical Group Teams, if applicable, and/or other HPI and/or provider meetings. When applicable, the Service Specialist is a member of a Medical Group Team and includes a Medical Director, Quality Assurance representative and Medical Management representatives. The Service Specialist is responsible for presenting and interpreting to key provider participants the management and financial reports developed for improving provider's delivery of managed care services for HPI Products.

* Coordinate and implement new provider relationships for designated HPI products. This includes completion of a work plan, coordinate key HPI department connection with medical groups, and establish medical group team relationship.

* Complete special projects that are identified through provider relationships, HPI Directors or Managers. Examples of projects are designing a generic referral authorization form for provider usage, updating provider manuals, creating new product information documents, coordinating the implementation of electronic connectivity programs, creating new provider reports and streamlining internal processes that involve several internal departments.

* Develop and implement audit procedures to determine that contracts have been implemented correctly on the HealthPartners claims processing system.

Required Qualifications: * Bachelor's degree.* Strong verbal and written communication skills. * Excellent problem identification/solving skills. * History of establishing diplomatic working relationships with providers and co-workers. * Intermediate level PC skills. * Strong organizational skills and ability to work independently. * Current, valid, unrestricted Driver's License (in the state of residence) free of major traffic violations or a pattern of repeated violations for the last 3 years and daily access to a reliable, insured vehicle.

Preferred Qualifications: * Three to five years of managed care experience in a member service, medical management, provider relations, or claims position. * Four years of provider relations experience in a managed care setting (HMO, PPO). * Provider perspective as evidenced by two years experience in a healthcare setting.
This position offers the flexibility to work remotely with preference to candidates residing in our coure service area of Minnesota and surrounding states.

HealthPartners is recognized nationally for providing outstanding care and experience for patients and members. We offer an excellent salary and benefits package. For more information and to apply go to www.healthpartners.com/careers and search for Job ID # 66319

Additional Information:

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

 

Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
3 to 5 years
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