INTERNAL PROVIDER RELATIONS REPRESENTATIVE

Arcadian Health PlanPosition Description Position Title: Internal Provider Relations RepresentativeDepartment: Network ManagementReports To: Executive Director, Regional Vice President, Regional Manager, Provider Relations Manager, or Director of Network ManagementFLSA Status:  ExemptWork Hours:  Monday through Friday, 8:00 am to 5:00 pmPrepared By: Donna JenningsPrepared Date: 3/1/2007Approved By: Approved Date:  Summary:  Provide internal support to the Health plan in contracting, recruiting, network development, provider orientation and education, resolution of provider issues, provider projects, data management and provider network communications.  Essential Duties and Responsibilities:  Create and maintain Provider Database Create and maintain HSD tables Collect and submit credentialing information – continue with follow up through to completion Provider directory creation, maintenance and distribution Welcome Letters and packets to new providers Set up users and sites in AOS Monitor MAGS daily Submit physician counts weekly PCP lists to enrollment monthly File and contract maintenance  Work directly with providers and provider groups to resolve issues relating to claims payment, eligibility, reporting and other issues as they arise May be required to assist with provider meetings outside of office Work with team to review AOS queue issues Work with team to review claims AP reports Any other duties as required. Role Essentials Experience and Education: Bachelors Degree with one or more years of relevant managed care/health care experience, or equivalent work experience. Strong verbal and written communication skills are required. PC skills are a must, including strong experience with Microsoft Office Products.  Language Skills Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of organization. Mathematical Skills Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Reasoning Ability   Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations. Computer Skills  Must be proficient in MS OFFICE with emphasis on Word, PowerPoint and Excel. Certificates, Licenses, Registrations Must possess valid, current driver’s license. Other Skills and Abilities  Other Qualifications    Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  Office environment, ability to operate automobile – long distance driving may be required.  Ability to travel.