Provider Engagement Representative

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you’re starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE The Provider Engagement Representative is responsible for servicing providers through public relations, problem solving, education, communication and support of Company policies and procedures. This role will provide education, training, and support for all providers. This position will also work to establish and maintain Medicaid CMO communications protocols, education, training, and schedules.

ESSENTIAL JOB DUTIES Works directly with providers to ensure they are serviced, maintained, and educated on all policies and procedures in an efficient and professional manner Manages collaboration with other departments and outside entities to meet identified needs of the providers and their patients, while also ensuring that other staff cooperate with these entities Provides positive, supportive communication to providers at all times Provides content for the Provider Insider Newsletter to ensure approved messages and communication comply with Provider Notification requirements Acknowledges any grievances and complaints within 1 business day of notice and resolves the issue within 30 days. All notes and communication are clearly documented within the appropriate workflow to ensure adequate tracking of the resolution of the complaint Assists with ensuring providers are compliant with the NCQA requirements regarding availability and access standards and also evaluates the standards to ensure they address the requirements outlined by NCQA Facilitates provider surveys and communications required for NCQA compliance Provides education, coaching and guidance to providers regarding HEDIS measures, CMS programs and any other quality initiatives for members Gathers provider opt-in forms for various contracted entities that fall under HOA (Medicaid CMOs, Tricare, PHS/CI, etc.) Assists Contracting, Credentialing and Network Management in loading new providers and completing contract/credentialing files Works with Network Management to ensure provider updates are sent for processing timely and ensures updates are performed accurately within the system Assists in research and problem resolution on issues related to claims processing incorrectly and works with the Claims Department to find resolution Reviews claim reports for denials and works with providers to improve claim submissions and provider data updates to ensure accurate claim adjudication Creates, audits, and distributes provider reporting as necessary Facilitates messenger model activities with health plan partners Encourages web-site and provider portal utilization through education and training to ensure providers can maximize the website and portal to best service their practices and patients Maintains provider and patient confidentiality at all times Keeps current in changes and trends that affect the Managed Care Industry Maintains regular and predictable attendance Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice Works to encourage and promote Company culture throughout the organization Other duties as may be assigned

QUALIFICATIONS Bachelor’s Degree in Health Care Administration, Nursing, Business, or related field preferred Valid Driver’s License Broad-based business experience within the healthcare/managed care environment

PHYSICAL REQUIREMENTS Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

BENEFITS 401K (4% Match, Immediate Vesting) Accident insurance Competitive salary Critical Illness Insurance Dental Insurance Employee Assistance Program Flexible Spending Account Health & Wellness Program Health Savings Account Life & AD&D Insurance Long Term Disability Medical Insurance Paid Time Off Pet Insurance Short Term Disability Vision Insurance

PRE-EMPLOYMENT SCREENING Drug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.