Provider Relations Representative
The Southeast Permanente Medical Group, New York, New York, United States
The Southeast Permanente Medical Group, (TSPMG)/ Kaiser Permanente is happy to announce an opening for a
Provider Relations Representative .
Description The Provider Relations function will ensure successful contractual relationships with community providers. TSPMG Provider Relations Representative has the primary responsibility of interacting with community "physicians", primary function is to act as liaison between the community provider and Kaiser Permanente. This position will educate, address issues related to contract administration and present practice management reports.
Job Functions
Negotiates/re-negotiates contracts with physician groups. (single, multi-specialty, IPA/PHO Agreements)
Acts as a liaison between contracted community providers and Kaiser Permanente to provide training to KP Policies and procedures and also address issues relating to contract administration.
Promotes good provider relations by conducting on site visits on a routine basis to address operational issues as they relate to community providers, i.e. lab, X-ray services as well as evaluating contract compliance.
Keeps manager informed of any issues surfacing during communication with the community provider.
Keeps community providers apprised of any program changes (i.e. issues relating to coverage, membership, personnel and benefits).
Maintains database for community providers.
Provides feedback to the appropriate management personnel when issues are identified relative to patient care, billing and authorization.
Works closely with Department of Quality Risk Management, Business Office, Member Services, Claims, Health Plan and Medical Audit to identify and resolve operational issues relating to contract development, administration, and to facilitate quality of service and reimbursement.
Implementation of newly developed contracts by providing on-site training and orientation to the community providers' office staff.
Your access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform your job.
Responsible to maintain knowledge of the top ten network PCP and OB-GYN offices (according to HMO volume) in assigned territory.
Hold meetings with providers to discuss practice management reports.
Execute special projects assigned by Director or Manager.
Minimum Experience And Education
Bachelor’s degree
Two years job experience
Preferred Experience And Education
Knowledge of Medicare, Medicaid, regulatory requirements and practice protocols
Knowledge of Value-Based Contracting
Knowledge of Network Adequacy Reporting
Knowledge of quality assurance and utilization management concepts
Knowledge of KFHP contracting process, benefits coverage, QA goals and objectives, medical referrals processing procedures
Knowledge of Network Adequacy Reporting
Knowledge of Value-Based Contracting
The Southeast Permanente Medical Group (TSPMG) is one of Georgia’s largest independent, physician-owned, multi-specialty medical groups. More than 600 physicians and 200 associate practitioners work together in a unique integrated care model to provide high-quality care to over 315,000 Kaiser Permanente members. Care is delivered at 26 medical offices featuring state-of-the-art equipment, labs, imaging services, and pharmacies. We also provide surgical services and around the clock care at some of the area’s top hospitals.
TSPMG offers a competitive salary, a generous retirement package, paid time off, health, dental, vision, and life insurance, long and short-term disability, relocation allowance, and more. We also offer numerous clinical and non-clinical learning opportunities and physician leadership development.
Atlanta, our home for more than 30 years, is a thriving metropolis that blends southern charm with modern art, music and culture. Learn more about our beautiful southern city at www.atlanta.com.
We are an equal opportunity employer. All applicants will be considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status. We maintain a drug and nicotine free workplace and perform pre-employment substance abuse testing.
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Provider Relations Representative .
Description The Provider Relations function will ensure successful contractual relationships with community providers. TSPMG Provider Relations Representative has the primary responsibility of interacting with community "physicians", primary function is to act as liaison between the community provider and Kaiser Permanente. This position will educate, address issues related to contract administration and present practice management reports.
Job Functions
Negotiates/re-negotiates contracts with physician groups. (single, multi-specialty, IPA/PHO Agreements)
Acts as a liaison between contracted community providers and Kaiser Permanente to provide training to KP Policies and procedures and also address issues relating to contract administration.
Promotes good provider relations by conducting on site visits on a routine basis to address operational issues as they relate to community providers, i.e. lab, X-ray services as well as evaluating contract compliance.
Keeps manager informed of any issues surfacing during communication with the community provider.
Keeps community providers apprised of any program changes (i.e. issues relating to coverage, membership, personnel and benefits).
Maintains database for community providers.
Provides feedback to the appropriate management personnel when issues are identified relative to patient care, billing and authorization.
Works closely with Department of Quality Risk Management, Business Office, Member Services, Claims, Health Plan and Medical Audit to identify and resolve operational issues relating to contract development, administration, and to facilitate quality of service and reimbursement.
Implementation of newly developed contracts by providing on-site training and orientation to the community providers' office staff.
Your access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform your job.
Responsible to maintain knowledge of the top ten network PCP and OB-GYN offices (according to HMO volume) in assigned territory.
Hold meetings with providers to discuss practice management reports.
Execute special projects assigned by Director or Manager.
Minimum Experience And Education
Bachelor’s degree
Two years job experience
Preferred Experience And Education
Knowledge of Medicare, Medicaid, regulatory requirements and practice protocols
Knowledge of Value-Based Contracting
Knowledge of Network Adequacy Reporting
Knowledge of quality assurance and utilization management concepts
Knowledge of KFHP contracting process, benefits coverage, QA goals and objectives, medical referrals processing procedures
Knowledge of Network Adequacy Reporting
Knowledge of Value-Based Contracting
The Southeast Permanente Medical Group (TSPMG) is one of Georgia’s largest independent, physician-owned, multi-specialty medical groups. More than 600 physicians and 200 associate practitioners work together in a unique integrated care model to provide high-quality care to over 315,000 Kaiser Permanente members. Care is delivered at 26 medical offices featuring state-of-the-art equipment, labs, imaging services, and pharmacies. We also provide surgical services and around the clock care at some of the area’s top hospitals.
TSPMG offers a competitive salary, a generous retirement package, paid time off, health, dental, vision, and life insurance, long and short-term disability, relocation allowance, and more. We also offer numerous clinical and non-clinical learning opportunities and physician leadership development.
Atlanta, our home for more than 30 years, is a thriving metropolis that blends southern charm with modern art, music and culture. Learn more about our beautiful southern city at www.atlanta.com.
We are an equal opportunity employer. All applicants will be considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status. We maintain a drug and nicotine free workplace and perform pre-employment substance abuse testing.
#J-18808-Ljbffr