Kelsey-Seybold

Provider Relations Representative

US-TX-Pearland
2 weeks ago
Job ID
2017-18087
Category
Finance/Business Office

Overview

Provider Relations Representative 

Location: Pearland Administrative Office

Department: Kelseycare Managed Care

Job Type: Full-Time
 

COMPANY PROFILE

Kelsey-Seybold Clinic. Your Doctors for Life.

Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor.  Kelsey-Seybold is Houston’s largest community-based physician group, caring for more than 400,000 patients. With 19 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.​​

 

JOB SUMMARY

This position is responsible for provider outreach in support of developing and maintaining positive & professional relationships with current and potential Kelsey-Seybold and KelseyCare Advantage providers to ensure stable and geographically disperse networks for the Kelsey-Seybold commercial and Medicare Advantage health plans and KS Plan Administrators’ health plan products. Provider relations functions will include providing education, training, guidance, claims resolution and other duties as assigned.    

 

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

(A = basics; B = preferred)

 

EDUCATION

A.  Bachelor’s Degree (1 year experience equivalent to 1 year of college)

B.  5+ years experience in applicable healthcare administrative operations.

 

EXPERIENCE            

A . 

  • 3 years contract negotiation experience at a health plan or medical group.
  • Experience and ability in developing provider or facility networks, knowledge of claims processing, managed care plan benefits and utilization management                   
  • 3-5 years experience in provider relations

B. 

  • Demonstrated negotiation skills and ability to interpret provider contracts.
  • 5-7 years experience in provider relations preferred

LICENSES 

A.  Valid Texas Driver’s License and ability to travel                          

B.  Willingness to engage in local business travel

 

OTHER    

A. 

  • Demonstrated knowledge of CPT and ICD-10 coding and prior experience with reimbursement methodologies
  • Analytical and problem solving skills; ability to communicate effectively in writing and verbally                                
  • Demonstrated public speaking and presentation skills
  • Ability to work in a fast paced environment; demonstrated ability to perform multiple concurrent tasks with minimal supervision and meet deadlines
  • Proficient with Microsoft Word and Excel     

B. 

  • Proficient with Access and PowerPoint
  • Capable of managing a variety of complex issues while driving momentum of key projects

 

WORKING ENVIRONMENT

Clinical

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