PROVIDER & CONTRACT SERVICE REP - Remote - Internal Candidates Only


Job Summary

According to established policy and procedure, acts as a subject matter expert for First Choice Health (FCH) contracted providers (providers not assigned to a Provider Relations Representative). Responsibilities include communication about FCH's business model, contract management, credentialing status, claims related investigation, and provider related services to internal FCH departments. Contract management includes inquiries for fee schedules, claims processing questions and other network related subjects. Must have strong knowledge of FCH payor clients (groups who rent the network and have access to the provider's contract) and how those relationships work in order to educate and work effectively with the providers. Must possess the ability to make decisions within the job scope independently and be self-directed.  




Main Duties

  • Manages the provider relationship using policy and procedure, and professional experience to accurately respond to provider's questions. Questions may include claims or accounts receivable issues, internal FCH process issues or credentialing related inquiries.

  • Triage all calls coming to the Provider Relations general call queue.

  • Triage all internal provider related inquiries from other FCH departments.

  • Triage all external provider related emails/inquiries from the Provider Relations team email address and/or other FCH departments

  • Document all customer contacts utilizing system tools made available in order to track, trend, and report on all provider and payor issues.

  • Responsible for initiating new and re-credentialed standard provider contracts in all geographic regions (WA, AK, ID, OR and Big Sky)

  • Works in a team environment, across departments, to resolve provider issues. Use tact and diplomacy to communicate issues and resolution of issues to provider.

  • Participate in team meetings to maintain an understanding of payor and group administration.

  • Supports other FCH departments in resolving provider and/or contract issues.

  • Actively pursues and maintains an understanding of the healthcare market.

  • Responsible for understanding claims data and communicating to various audiences.

  • Other related duties as required.


Requirements

  • BS/BA or equivalent combination of work experience and education.

  • 3+ years experience in healthcare provider business operations and/or payor operations. May include working in provider relations, contracting, or in a clinical setting.

  • Proven ability, through job experience, to understand the complexity of claims processing and contract management.

  • Strong written and verbal communication

  • Ability to multitask in a fast paced environment. Ability to meet deadlines and organize work is required.


Our Benefits

Become a First Choice Health employee and enjoy our generous benefit package. We offer competitive benefits that are much beyond the traditional basics.

Click here to learn more about our competitive benefit package.


How to Apply

Please submit your resume to [email protected].

Additional information about our company may be found on our website www.fchn.com