Provider Relations Representative

Job Number
207074
University Physicians Health Plans
Shift
Day
Department
University Physicians Health Plans - HP Statewide ND
Position Type
FT: Full-Time
Street Address
2701 E. Elvira Rd.
City & State
US-AZ-Tucson
Posting Category
HIMS / Coding

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Banner University of Arizona Health Plans is currently seeking a Provider Relations Representative to join the Network Development Provider Relations Department.

 

The Network Development Provider Relations Department is responsible for helping to develop and maintain our network of PCPs, specialists, hospitals and ancillary providers. Each contracted provider is assigned a Provider Relations Representative. The Network Development Provider Relations Department coordinates with other departments and agencies to provide valuable information on services and programs. 

 

Schedule:

Full time, Day shift: 8:00AM-5:00PM (flexible)

 

Location:

525 W Brown RD

Mesa, AZ 85201

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About University Physicians Health Plans
The University of Arizona Health Plans (UAHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care.

 



Truven-2013
Stage7-2013

About Banner Health
Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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Job Summary

This position responds to and resolves advanced to complex level issues related to the daily administration and operation of potential and existing providers and may involve provider education, interpreting and developing policies, procedures and guidelines. Provides in-service to appropriate personnel in regard to changes and updates in system support files.


Essential Functions

  • Travels frequently to physicians offices doing site visits, educating office staff, recruiting new offices, and resolving established problems.

  • Provides education to physicians and their office staff. This includes, but is not limited to coordinating orientation and education of providers, hospitals and the organizations insurance plan administration staff.

  • Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues.

  • Maintains all levels of communication with network providers, informing them of any operational, procedural, and contractual changes and updates.

  • Assists internal departments in resolving provider and member appeals pertaining to the organizations physician, hospital, and insurance plan contracts.

  • Assists manager with network development in various geographic regions within the organization, negotiates, implements and maintains managed care contracts with payers and providers.

  • Minimum Qualifications

    Must possess a strong knowledge of healthcare as normally obtained through the completion of a bachelors degree in business, healthcare administration, or related field.

    Must have an excellent understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding.

    Must know how or learn to program data retrieval utilities and queries. The incumbent must possess the ability to track and analyze statistical data. This position requires a mathematical aptitude, computer experience, typing skills and the ability to work on a variety of projects in an organized fashion.Must have the ability to effectively communicate both verbally and in writing.

    Preferred Qualifications

    Three years of experience in the healthcare field preferred. Two years of medical claims auditing experience is preferable.

    Additional related education and/or experience preferred.