Provider Relations Representative
: Job Details :

The Provider Relations Representative for the Western Region will cover the following (and possibly additional surrounding) counties: Allegany, Cattaraugus, Chautauqua, Genesee, Livingston, Orleans, and Wyoming.Applicants who reside in Jamestown, Olean, Ellicottville, Dunkirk, Houghton, and surrounding cities are encouraged to apply.Responsible for maintaining working relationships within all vendors, both out-of-network vendors and within the provider network, as well as community relations contacts. Maintain accurate and current provider databases relating to provider facilities and credentialing information. Perform audits of electronic provider files, credentialing, contracting materials and claims submissions to ensure all contracted providers follow policies and procedures.Performance Responsibilities and Standards:Assists in the day-to-day operations of the Provider Relations department.Research, contacts, and works to secure agreements with vendors who provide covered services in compliance with plan requirements. Obtains new service provider application and all necessary credentialing, and forwards to Provider Relations Credentialing & Contract Management Specialists to be processed.Prepares contracts and addendums to be executed between plan and providers.Resolves all concerns raised by providers and provides up-to-date information on all new and existing policies and procedures.Directs vendors to the correct contact persons at Nascentia and assists with addressing outstanding issues or concerns with other departments, including but not limited to claims processing, care management, enrollment, member services and transportation.Executes team-based projects promptly, with routine follow-up, as needed (i.e., securing amendments to satisfy new NYSDOH directives, distribution of notifications via mail, phone, or email, execution of Nascentia directives, etc.)Completes triennial, and as needed, desk audits of current provider records and secures re-credentialing from providers in accordance with NYS requirements. Performs site-visits as required, to all provider locations where members receive face-to-face services.Performs site-visits and inspections at all social adult day cares within the assigned region, annually and in accordance with established OMIG requirements.Provides community and provider education in a variety of settings to include virtual meetings, conference calls, presentations, in-services, and general drop-in/check-in visits.Maintains working relationships with DSS and OFA contacts in the representative's assigned counties.All other duties as required.Requirements:Bachelor's degree or relevant experience in the healthcare industry.Exposure to procedure interpretation and provider networking.Knowledge of Medicaid managed long term care policies.Knowledge of Medicare dual special needs plan policies.Knowledge of ICD-9 and CPT codes desired.Strong analytic and problem-solving abilities.Strong communication and negotiation skills.Valid New York State driver's license.Computer literacy, including but not limited to data entry, retrieval, and report generation.Ability to drive to and from a variety of settings in varying weather conditions.Ability to perform physical tasks which include sitting, standing, walking, pushing, pulling, climbing stairs, bending, and may include lifting a minimum of 40 pounds.Physical Requirements:Position requires a mixture of sitting, standing, and walkingVisual ability sufficient to read data on computer screen and paper documentsVisual/hearing ability sufficient to comprehend written or verbal communication.Ability to express self verbally and in writing.Ability to drive in varied weather conditions throughout the year.Ability to use telephone and communicate over the phone.Bloodborne Pathogens Exposure Category III - Employee who rarely has contact with blood and body fluids.Competitive Salary[This position is an S01 exempt position with a min-max rate of: $58,500- $67,718] with:Retention BonusesInternal Mentoring Program401K with generous Employer matchOn-Site Gym (free for all employees)Medical, Dental, Vision plansTuition ReimbursementPartially funded HSAEmployee Recognition PlatformPaid Time Off, Holidays, Sick and Extended Sick LeaveShort/Long term DisabilityEmployee Assistance Program (EAP)Much More!About Nascentia Health:Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.Nascentia Health is an Equal Opportunity Employer (EOE)Employment is contingent upon negative results of a pre-hire drug screen