Provider Relations Representative II - Baylor MedCare (90002076)

Baylor College of Medicine

Houston, TX

ID: 7074042 (Ref.No. 5774-en_US)
Posted: January 13, 2021
Application Deadline: Open Until Filled

Job Description

Job Purpose

Develops and maintains positive relationships with department contacts and contracted payers. Identifies, researches and resolves provider load issues with managed care contracted payers through the use of dedicated systems and/or self-directed analysis. Manages payer reports for add, changes and terminations. Manages internal provider rosters. Assist and performs as back up with credentialing manager task when needed.

Job Duties

  • Develop and maintain positive relationships with physicians, providers, BCM management and department contacts throughout the college.
  • Build and preserve relationships with the organization's contracted payers.
  • Manage monthly payer reporting process. (Adds, Updates/Changes, Terms)  
  • Generate, analyze, and format multiple excel reports with data pulled from CACTUS queries.
  • Format reports based on payer requirements.
  • Generate PDF provider profiles.
  • Submit reports and profiles to all a payers.
  • Request to load each provider with all contracted plans and products.
  • Manage monthly Rosters. Monthly Rosters(Includes all credentialed providers).
  • Submit generated rosters to payers and BCM departments.
  • Provide weekly written communication to department manager of pending/resolved issues.
  • Identify and resolve problems for the BCM clinical departments regarding contracted managed care organizations.
  • Ensure provider data accuracy across all platforms.
  • Provider Load Validation/Effective date report.
  • Validate with payers on a monthly basis that all adds, updates/changes, and terms submitted with monthly payer reports were completed.
  • Load confirmation: generate a report with load validation status of each credentialed provider. Submit information to the billing group.
  • Roster compare: work with payers to clean up data, we compare our rosters against their rosters to validate all information and make any changes and updates accordingly.
  • Act as a subject matter expert to BCM clinical departments regarding provider, contract and policy issues.
  • Identify, research, and resolve accounts with highest levels of complexity and difficulty.
  • Manage daily Service Now tickets for provider loads in Epic. (Validation of providers information on ticket and approval) and Payer PIN loads.

Minimum Qualifications

  • Bachelor's degree in healthcare, management, business or related field, or equivalent work experience. Four years of relevant experience may substitute for degree requirement.
  • Three years directly related experience.

Other

  • Exceptional written and verbal communication skills.
  • Expertise in Medicare, Medicaid, managed care, and commercial insurance healthcare.
  • Strong interpersonal skills.
  • Excellent problem-solving ability.
  • Excellent organizational skills.
  • Processes of improvement to maintain providers in compliance with government, managed care and commercial payers.

 

 

 

 

Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.

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Baylor College of Medicine fosters diversity among its students, trainees, faculty and staff as a prerequisite to accomplishing our institutional mission, and setting standards for excellence in training healthcare providers and biomedical scientists, promoting scientific innovation, and providing patient-centered care. - Diversity, respect, and inclusiveness create an environment that is conducive to academic excellence, and strengthens our institution by increasing talent, encouraging creativity, and ensuring a broader perspective. - Diversity helps position Baylor to reduce disparities in health and healthcare access and to better address the needs of the community we serve. - Baylor is committed to recruiting and retaining outstanding students, trainees, faculty and staff from diverse backgrounds by providing a welcoming, supportive learning environment for all members of the Baylor community.



 

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