Brief job description:
This position acts as a key liaison between CPMG’s primary care physician network, ancillary providers, health plans, and other partner organizations. The Provider Relations Representative is responsible for the development and maintenance of positive working relationships with all partners by collaborating on complex organizational initiatives across the integrated delivery system.
- Works directly with senior management to create and implement policies/procedures for network of contracted providers in order to further CPMG’s strategic plan.
- Educates (as a primary responsibility) contracted offices, including physicians, administrators and billing staff, on CPMG/RCHN initiatives, serving as a liaison to CPMG administration.
- Receives, researches, and responds to unique, complex inquiries from providers and senior leadership with minimal supervision.
- Manages provider related issues, grievances and concerns of a complex nature, with a high level of professionalism.
- Prepares presentations for committee and/or board meetings relative to Provider Relations initiatives.
- Acts as a subject matter expert (SME) on the operations of CPMG’s network of providers, including office performance, structure, and nuances.
- Initiates corrective action plans for contracted providers, including contract and legal review when appropriate.
Minimum job qualifications (education, experience, certification, skills, etc):
- Three (3) years’ direct experience in managed care, with working knowledge of IPA/Medical Group, health plan/HMO operations, physician office management, or an equivalent combination of education and related experience.
- High school degree or equivalent education; Bachelor’s degree preferred.
