Perform duties to act as a liaison between providers, the health planand Corporate.
Perform training, orientation and coaching for performanceimprovement within the network and assist with claim resolution.Job Responsibilities:
Serve as primary contact for providers and act as a liaison between the providers and the health plan
Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution
Receive and effectively respond to external provider related issues
Provide education on health plan’s innovative contracting strategies Initiatedata entry of provider-related demographic information changes and overseetesting and completion of change requests for the network
Investigate, resolveand communicate provider claim issues and changes
Educate providers regardingpolicies and procedures related to referrals and claims submission, web siteusage, EDI solicitation and related topics