Intermountain Healthcare Provider Network Engagement Representative - SelectHealth in Salt Lake City, Utah
Greater Salt Lake area
What does it mean to be a part of Intermountain Healthcare? It means that the quest for clinical excellence is not just a goal, but a given. It means building an environment where physicians and employees can deliver the best in healthcare. And it’s realizing each employee or volunteer is vital to the healing process, because we can only achieve theextraordinary together .
Being a part of Intermountain Healthcare means joining with a world-class team of over 36,000 employees and embarking on a career filled with opportunities, strength, innovation, and fulfillment. Our mission is: Helping people live the healthiest lives possible.
Our patients deserve the best in healthcare, and we deliver.
The Network Engagement Representative works with participating practitioners to achieve effective working relationships and participating physician satisfaction by developing relationships of trust and demonstrating sound business decisions. May work with regional hospital leaders.
Essential Job Duties
1. Establishes and maintains effective business relationships with providers. Acts as a liaison between provider offices and the organization to help build and maintain effective relationships. Understands, educates and supports and acts as a liaison to providers for Primary Care Clinical Programs (PCCP).
2. Visits target providers to educate them about SelectHealth products and clinical programs, and reviews reports relevant to their practices.
3. Provides input and recommendations on decisions that affect physicians as determined by manager.
4. Acts as a resource to provide and/or direct offices to information on policies, procedures, services and programs. Ensures maintenance of open lines of communication to anticipate and resolve issues, gathers information for policy steering, and communicates any changes to offices.
5. Executes contracts with individual practitioners for new and existing SelectHealth products.
6. Supports physician offices in complying with internal policies and NCQA requirements. Uses working knowledge of basic coding and reimbursement policies, directory listings, panel participation and NCQA accreditation to assist in addressing issues when providers are not in compliance with internal policies and NCQA requirements.
7. Uses sound judgment to facilitate and recommend changes to internal policies and procedures where necessary.
8. Provides education to physician offices regarding industry and market trends.
9. Anticipates and recognizes issues and is proactive in problem resolution. May oversee the problem solving process.
10.Uses working knowledge of the available panels / networks to appropriately guide and educate providers.
11.Researches and prepares information to present at the Participating Practitioner Steering Committee (PPSC). Participates in PPSC committee to determine provider status on networks.
12.Using understanding of fee schedule methodology, explains process to providers and office staff. Acquires fee schedule information and input from providers. Provides information to Provider Contracting to support them in developing fee schedules. Resolves issues like panel eligibility and fee schedules.
13.Determines appropriateness of Special Payment Requests (SPR) as needed.
14.May be asked to lead or facilitate special projects related to market trends and strategic direction.
15.May directly or indirectly supervise and/or mentor Provider Relations Coordinator/s. May assign tasks and provide guidance in prioritizing and balancing workload to ensure completion of work. May perform one-on-one assessments on a monthly basis. May complete or assist the manager in completing annual performance evaluation and corresponding verbal discussion. May help set appropriate individual goals in support of department and company goals.
- Benefits Eligible: Yes
- Shift Details: Full-time, Exempt
- Department: SelectHealth - Provider Development
- Bachelor's degree in Health Care Administration or business related field. Degree must be obtained through an accredited institution. Education is verified. or Four years of professional experience in health care.
- Four years of experience working with health care providers at a professional sales or service position.
- Demonstrated intermediate skills in word processing software.
- Manual dexterity, hearing, speaking, seeing.
- Excellent presentation and communication skills.
- Demonstrated effective interpersonal and problem-solving skills.
- Experience taking proactive initiative.
- Demonstrated ability to make business and strategic suggestions.
- Health insurance claims payment system experience.
All positions subject to close without notice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
Working Hours 40
Primary Work Location SelectHealth
Expertise Business / Administration
Job Type Full Time
Location US-UT-Murray, US-UT-Salt Lake City