Provider Network Operations Representative
Apex Health Solutions
Summary: Provider relations representatives are liaisons with healthcare providers. They are responsible for creating long-term relationships with providers and engaging with them regularly to ensure they are appropriately informed and updated on products, service offerings, and the latest technology available to them. Essential Duties and Responsibilities: Establishing and maintaining relationships with assigned healthcare providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service. Orient and train providers regarding the company's operations for both the Medicare Advantage and Commercial lines of business. Ensure providers are aware of and have the appropriate training, resources, and an understanding of expectations as it relates to regulatory requirements as provided by CMS and/or Texas Department of Insurance Develop and distribute communication materials, including provider service manuals, provider management reports, network directories and other materials as necessary Evaluate and monitor providers’ KPIs and financial metrics and performance of contracts and coordinate partnership meetings with Providers, large groups, and vendors Analyze data prior to Provider meetings, identifying opportunities, and initiating improvement ideas. Work with internal staff to resolve provider issues around billing, denials, payment, authorization, interaction and other provider issues Education/ Experience: Bachelor's degree in healthcare administration or equivalent. Minimum of 2 years' experience in provider relations or equivalent account management experience Proficiency in creating presentations, training documents, and reports. Proficiency in MS Outlook, Excel, Word, and PowerPoint. Ability to work independently Excellent communication skills (written and verbal) and interpersonal skills Good problem-solving skills. Excellent customer service skills, time management, and organizational skills Local travel to provider offices in and around the Greater Houston area required ABOUT APEX HEALTH SOLUTIONS Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Apex’s unique solutions create alignment between payers and providers, generating unparalleled value. Combined with Apex’s experienced and successful industry leadership, our focal point remains on improvement in patient quality, satisfaction and overall cost of care.
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