HealthCare Operations Representative

Position : Relations Provider / HealthCare Representative

Location : Baltimore, MD #HYBRID (should come to office when required)

Duration : 6+ months Contract

In-Person Interview

Rate : $30 / hr

Job Description :

• Looking for Operations or Relationship -Representative with Healthcare experience
• This role responsible for developing and maintaining positive constituent relationships with providers, operational departments, health institutions and other entities, handling escalated issue management and dispute resolution activities.
• Serves a primary liaison to provide communication, education, issue resolution and support to network providers.
• Education Level : High School Diploma
• 4 years experience in the health care industry, including experience working experience with providers, training, claims, customer service and presentations.
• Preferred : Bachelor's Degree in business, healthcare administration or related industry
• Partners with Provider Training and Education Department to educate providers
• Provide research, analytic and resolution support on the project when required
• Provide research, analytic and resolution support on all policies and contractual guidelines are clearly identified
• Required Excellent communication, written and presentation skills
• Required experience with insurance plan, healthcare insurance or a physician hospital organization (PHO)
• Working knowledge of provider billing and coding mechanisms., Proficient
• Thorough knowledge of managed care industry legislated and regulated requirements, health care financial matters and third-party payment methodologies., Proficient
• Understanding of contractual documents and ability to effectively communicate terms to providers., Proficient
• Working knowledge of Microsoft Excel, Microsoft Access, Microsoft PowerPoint and Microsoft Word., Proficient

ESSENTIAL FUNCTIONS :

25% Partners with Provider Training and Education Department to educate providers ensuring they are engaged in the value of our programs in support of positive member interactions. Provide ongoing and targeted basic training and education to our provider community ensuring they can successfully utilize electronic tools, navigate provider portal, follow processes and procedures.

20% Involved in supporting one or more health systems, representing multiple practices, enabling the organization to provide Tier One Service.

20% Provide research, analytic and resolution support for less complex special projects.

15% Provide research, analytic and resolution support on special cases and projects ensuring that all policies and contractual guidelines are clearly identified as required by the case. Provide verbal or written responses to inquiries to management and other internal and external customers. Acts as a resource and provides needed assistance to providers in resolving escalated service-related issues and timely response to provider inquiries via face to face visit, correspondence, e-mail, phone, etc.

10% Build and maintain appropriate relationship with providers by ensuring regular communications and timely problem resolution. Leverages provider relationships to drive and influence provider behavior towards favorable outcomes

10% Proactively identifies provider needs and responds appropriately through problem solving, engagement of other internal or external resources, and providing high level service

Thanks & Regards,

LAXMAN

Team Lead - Talent Acquisition

KMM Technologies, Inc.

CMMI Level 2 | ISO 9001 | ISO 20000 | ISO 27000 Certified

WOSB, SBA 8(A), MDOT MBE & NMSDC MBE

Contract Vehicles : 8(a) STARS III & Schedule 70

Tel : (240) 800-0039 |Email : lax@kmmtechnologies.com