Sr. Provider Relations Liaison
Location: Pearland Administrative Office
Department: Mgd Care Communications
Job Type: Full Time
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.
The Senior Provider Relations Liaison is responsible for establishing and maintaining strong positive business relationships with current and potential Kelsey-Seybold and KelseyCare Advantage affiliate and employed 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. Responsibilities include providing educational instruction and support to physicians and their staff. The Senior Provider Relations Liaison will be the main point of contact for the respective providers and will routinely visit physician’s offices for issues concerning the achievement of provider satisfaction, medical cost targets, network growth and/or efficiency targets. This role includes responsibility for education of the physicians and office staff on health plan products and benefits, policy and procedure for multiple managed care plans, assistance with claims payments and other duties as assigned. Travel requirements – local and extensive.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
Bachelor’s Degree (1-year experience equivalent to 1 year of college)
5+ years’ experience in applicable healthcare administrative operations.
5+ years contract negotiation experience at a health plan or medical group.
5+ years’ experience in provider relations or network management with a demonstrated ability to perform network development and/or provider relations.
Experience with developing provider and/or facility networks. Must possess a knowledge of claims processing, managed care plan benefits and utilization management policies and procedures.
Demonstrated negotiation skills and ability to interpret provider contracts and regulatory contracts.
3+ years of experience in Medicare/Commercial products
Valid Texas Driver’s License and ability to travel. Must own or lease a working vehicle and be able to travel daily within the Greater Houston area.
Demonstrated knowledge of CPT and ICD-10 coding and prior experience with reimbursement methodologies
Proficient with Microsoft Word and Excel
Analytical and problem-solving skills; ability to communicate effectively in writing and verbally
Proficient with Excel and/or PowerPoint
Ability to work in a fast-paced environment; demonstrated ability to perform multiple concurrent tasks with minimal supervision and meet deadlines
Demonstrated public speaking and presentation skills
Capable of managing a variety of complex issues while driving momentum of key projects