Provider Concierge Representative - Care 'N Care
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Provide Customer Service to Providers
Provide health plan updates, education, resources, training, guidance to providers and their staff. Be creative, contribute to developing, implementing provider education materials and resources. Attend to provider issues/concerns in a timely manner. Conduct health plan Welcome Orientations to new providers plus their staff. Be the primary contact for participating providers in the network. Strive for provider satisfaction with health plan overall.
Resolve Complex Provider Issues
Identify issues and how it may affect other health plan department operations. Contribute to identifying the root cause, problem solve, make decisions, interpret data, organize and analyze. Escalate any trends identified and share findings with department. Collaborate with other departments to address any complex issues in an attempt to resolve them in a timely manner. Maintain open communication with providers on status of their issues.
Track and Document Daily Activities in a Timely Manner
Document in systems daily activities and communication with internal/external customers accurately, timely and clearly.
Participate with other Departments on Health Plan Initiatives to Improve Provider Performance
Contribute to creating provider education materials and resources. Getting providers to actively participate in health plan programs/projects. Coordinate with provider offices to review reports.
Qualifications
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High School Diploma or Equivalent (required)
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Bachelor's Degree in Healthcare, Marketing, Communications, Public Relations, Business or Relevant Area of Study (preferred)
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2 years’ experience in Healthcare, Managed Care, Insurance, Provider Relations or Account Management (required)
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1 year Medicare Advantage experience (preferred)
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1 year Claims Billing/Coding knowledge (preferred)
Position Responsibilities SWHR Provider Concierge Representative will
Establish and Maintain Strategic Partnerships with Providers
Communicates the vision and goals of the health plan to support the development of the highest possible provider partnerships. Collaborate with providers, especially primary care and their staff to ensure their practice improves their RAF and Quality results. Explain reports to providers and their staff that directly drive results related to health plan initiatives. Shares best practices with providers’ exercise of discretion, judgment and make recommendations for actions that will drive results. Create partnerships with IPA's to maintain open communication with extended providers. Flexible schedule and availability to attend business meetings. Provide professional, timely and accurate direct customer service to internal and external customers.
Provide Customer Service to Providers
Provide health plan updates, education, resources, training, guidance to providers and their staff. Be creative, contribute to developing, implementing provider education materials and resources. Attend to provider issues/concerns in a timely manner. Conduct health plan Welcome Orientations to new providers plus their staff. Be the primary contact for participating providers in the network. Strive for provider satisfaction with health plan overall.
Resolve Complex Provider Issues
Identify issues and how it may affect other health plan department operations. Contribute to identifying the root cause, problem solve, make decisions, interpret data, organize and analyze. Escalate any trends identified and share findings with department. Collaborate with other departments to address any complex issues in an attempt to resolve them in a timely manner. Maintain open communication with providers on status of their issues.
Track and Document Daily Activities in a Timely Manner
Document in systems daily activities and communication with internal/external customers accurately, timely and clearly.
Participate with other Departments on Health Plan Initiatives to Improve Provider Performance
Contribute to creating provider education materials and resources. Getting providers to actively participate in health plan programs/projects. Coordinate with provider offices to review reports.
In addition to the required qualifications, a successful Provider Concierge Representative will:
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Demonstrate a general knowledge of healthcare delivery systems;
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Able to interpret reports, prioritize assignments, evaluate the accuracy of data and effectively communicate results;
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Ability to create action plans to support the reports in an effort to drive results;
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Must be able to multitask, participate in projects, identify priorities, problem solve, make decisions, organize and analyze workflow, write, plan, use math method formulas, and simple arithmetic;
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Have the ability to communicate professionally in writing and verbally with internal and external customers;
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Creative in developing education materials for providers;
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Able to develop and maintain provider partnerships for the health plan;
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Ability to exhibit confidence when working directly with physicians and their staff;
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Flexible schedule and availability to attend business meetings;
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Must be able to operate general office equipment including but not limited to computer, phones, related media and information devices;
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Possess intermediate knowledge of Microsoft Word, Excel, Power Point, QNXT, Facets, Ring Central and Salesforce;
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Dependable, self-motivated, creative, solution focused and exhibits initiative;
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Remain composed in emotionally stressful situations at all times
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Ability to work well on a team and independently;
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Must be able to provide excellent customer service to internal and external customers;
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Reliable transportation and driver's license.
Why Southwestern Health Resources
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
Moving healthcare forward
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
We invite you to learn more about us at www.southwesternhealth.org.
Let’s move healthcare forward – together.
Highlights:
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Combining the strengths of UT Southwestern Medical Center, Texas Health Resources and more than 2,500 community physicians, we offer the largest provider network in North Texas. SWHR covers approximately 700,000 patient members across 16 counties in North Texas.
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SWHR is the parent organization of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.
Additional perks of being a SWHR Provider Concierge Representative
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Gain a sense of accomplishment by contributing in a teamwork environment
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Positively impact patients’ quality of life
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Receive excellent mentorship, comprehensive training and dedicated clinical leadership resources
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Enjoy opportunities for growth
Explore Southwestern Health Resources Careers for more information and to search all career opportunities.
Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org.