TX STAR+PLUS Network Relations ConsultantPrimary Location: Dallas, TX
Additional Locations: TX-Dallas, TX-Ennis, TX-Grand Prairie, TX-Greenville, TX-Irving, TX-McKinney, TX-Plano, TX-Terrell Apply
This position requires routine and frequent travel in the field. Travel is with a personal vehicle approx. 50-75% of the time. The work schedule includes one day a week, Mondays, in the Dallas office for administrative tasks. The Network Relations Consultant acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Candidates must have active and valid TX driver's license, reliable transportation and vehicle insurance.
- Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
- Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
- Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
- Performs credentialing support activities as needed.
- Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
- Meets with key providers periodically to ensure service levels are meeting expectations.
- Manages the development of agenda, validates materials, and facilitates external provider meetings.
- May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
- Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.
- May provide guidance and training to less experienced team members.
- Minimum of 3 years experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.
- 3-5 years experience with business segment specific policy, benefits, plan design and language.
- Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.
- Ability to perform root cause analysis and the ability to translate complex information into simple terms is a plus.
- Working knowledge of business segment specific codes, products, and terminology.
- Bachelor’s Degree OR equivalent combination of education and experience.
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
- Previous experience in a similar role, i.e., Provider Relations Representative or Provider Relations Liaison in Govt Sector(Medicare/Medicaid) highly desired.
- Project management, public speaking, claims and call experience is a plus.
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