Job Description
Department:
Provider Relations
Location:
Houston
Job Title
Physician Relations Representative
Reports to:
VP, Physician and Patient Relations
Full-time Office Operations
Working w/ Clients
Hours_40_ / week
Exempt
General Description/PURPOSE
Be part of a team that values strong work ethic, critical thinking skills, and perseverance! The Physician Relations Representative is the frontline for managed care; establishing and strengthening the relationship between physicians, office staff, and managed care organizations. The Physician Relations Representative must be skillful in communication; ultimately setting goals and assisting office in meeting metrics-HEDIS, ER utilization, patient establishment. This position oversees and facilitates all aspects of needs for the physician office, while meeting goals for the Independent Physician Association. In this role, the Physician Relations Representative will routinely visit physician’s offices for issues concerning the achievement of provider satisfaction, medical cost targets, network growth and/or efficiency targets, education of benefits, policy and procedure for managed care plans, assistance with claims payments, financial compensation and marketing. Generally, work is self-directed and not prescribed; the individual must work with less structure, but more complex issues. Travel requirements – local and extensive.
COMPANY GENERAL POLICY AND PROCEDURE
Attendance: Is punctual and present. Will request time off in accordance with policy. Will document time worked and reasons for tardiness/absence or leaving early according to office policy.
The requirements listed below are representative of the knowledge, skill, and/or ability required. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The competence of the employee in performing his or her job duties will be demonstrated, maintained, and improved on an ongoing basis.
The statements contained in this position description reflect the general duties considered necessary to describe the principal functions of the job as identified, and shall not be considered a detailed description of all the work requirements that may be inherent in the position.
Job Responsibilities
- Develop the physician network of assigned territory (family practice, specialties, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management and produce a comprehensive product for business partners.
- Intermediary between Health Plans and physicians concerning provider participation, claim issues, additions, terminations, patient establishment
- Daily visits to physician offices (includes Primary Care and Specialists)
- Provide orientations and ongoing education to physicians and staff on health plan policies, procedures and resource information
- Develop a strong relationship with staff and physician to promote their growth in the network.
- Review bonus matrix with physicians for quarterly distribution.
- Proven ability to synthesize and translate competitive intelligence into decision-making process
- Analyze Data to identify cost driver and share/educate physicians on improvement options
- Provide advice/guidance/recommendations and insight to leadership regarding assigned territory
- Negotiates provider contracts as applicable
- Participates in quarterly Provider Forums
- Serves as a resource to others.
- Assist staff with proper claims payment when necessary.
- Actively seek resolution to difficult problems as identified by physician/office staff
- Assist Health Plans and Physicians with HEDIS compliance and data collection
- Works with other departments on a daily basis
- Assist with special projects
- Other duties as assigned
Financial Management
Work within approved budget; uses cost saving measures; contributes to profits and revenue.
Receive all appropriate approvals (e.g., purchase orders, expense reports) for incurred expenses
Customer Service
Interact with all visitors and fellow employees in a mature, responsible, courteous manner to ensure a positive and professional environment. Responds promptly to customer and coworker needs, and continually strives to improve service.
Maintain sensitive information in a confidential and professional manner.
Required Qualifications:
- 3-5 years of experience in Physician Relations with a Physician Network or Health Plan
- Knowledge of Medicare Managed Care
- Reliable transportation, License in good standing and clean driving record
Preferred Qualifications:
- 5-10years of experience in Physician Relations with a Physician Network or Health Plan
- Knowledge of CMS Medicare Advantage Risk Adjustment, Star rating program, and HEDIS preferred
- Knowledge of Direct Medicare record collection and understanding of ICD9/ICD10, CPT 4 billing requirements preferred
- Reside in service area
- Bilingual
- Knowledge of claims processing and guidelines
- Strong interpersonal skills, establishing rapport and working well with others
- Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others (a critical thinker with presentation skills)
- Analytical/data drive decision-making skills
- Working knowledge of provider business operations
- Proven ability to synthesize and translate competitive intelligence into decision-making process
- Familiar with Microsoft applications - Outlook, Word, and Excel. Experience with Access a plus.
- Must be self-motivated and work independently; able to translate concepts into practice
Minimum Qualifications
- Education: Associates degree or higher preferred
- Licenses/Certifications: (None)
PHYSICAL REQUIREMENTS
While performing the duties of this Job, the employee is regularly required to talk or hear. The employee is frequently required to sit and use hands and fingers, handle, type, or feel. The employee is occasionally required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision and distance vision.
Machines/Equipment Used
Computers, copy machines, telephone, fax machine and other equipment as necessary
Environmental Conditions
Indoor climate-controlled environment; occasional exposure to outdoor climate. Moderate to quiet noise level.
Company Benefits
In a full-time permanent position, you will be able to participate in our company benefit program which includes:
- Group benefits include medical, dental, vision, company paid $25k life with the option to add more voluntary life insurance coverage for employee and their family, STD, company paid LTD, 401k, and a variety of supplemental coverages such as hospital, cancer, legal, etc. available to the employee and their family.
- Employee funded HSA program.
- Paid Time Off ranging from 5-28 days depending on length of service.
- Profit Sharing Bonus Program
- 100% Employer Paid Pension Plan after 5 years
- Employer Sponsored Wellness Program with access to company gym and locker rooms in Houston offices
Job Type: Full-time
Pay: From $60,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible schedule
- Free parking
- Health insurance
- Life insurance
- Paid time off
- Travel reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Experience:
- Customer Service: 1 year (Preferred)
Work Location: In person