Provider Relations Analyst

Location:

Calmont Operations Building

Department:

Network Mgmt

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Position will report directly to the Manager of Provider Relations. This position will be the focal point for providers and provider offices by acting as the liaison between the physician community and the Provider Relations staff. This includes maintaining effective relationships with the physician community, including but not limited to physician education, facilitation and resolution of complex, urgent problems. Must be familiar with Texas Medicaid, claims resolution as well as coordinating and facilitating Provider and committee meetings, create and publish Newsletters, notifications, monitor MCO notices, resolve Provider complaints, update and audit Provider website, update codes on prior authorization look up tool and special projects as assigned by Provider Relations and Network Management Director. Must maintain emails/CRMs for Provider Relations inbox.

Additional Information:

Position will report directly to the Manager of Provider Relations. This position will be the focal point for providers and provider offices by acting as the liaison between the physician community and the Provider Relations staff. This includes maintaining effective relationships with the physician community, including but not limited to physician education, facilitation and resolution of complex, urgent problems.

Must be familiar with Texas Medicaid, claims resolution as well as coordinating and facilitating Provider and committee meetings, create and publish Newsletters, notifications, monitor MCO notices, resolve Provider complaints, update and audit Provider website, update codes on prior authorization look up tool and special projects as assigned by Provider Relations and Network Management Director. Must maintain emails/CRMs for Provider Relations inbox.

Education:

• Bachelors Degree preferred but will consider 10 years healthcare/provider and/or member services experience in lieu of degree.

• 1-2 years experience in a provider or member services role working with state regulatory agencies preferred.

• Familiarity with the provider community, presenting in a public setting and public speaking is desired.

• Medical billing and Healthcare industry knowledge a plus.

• Basic understanding of CHIP & STAR benefits, and NPI/TPI relationships for billing.

• Working knowledge of HMO business operations specifically member services, claims, credentialing and plan operations.

• Experience with Microsoft Office Suite (Outlook, Excel, Word, PowerPoint).

About Us:

Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.