JOB SUMMARY
The Provider Relations Specialist works in cooperation with the Contracting Manager – Marshfield Clinic Health System Provider Network and other department and organization colleagues to deliver superior service to our comprehensive network of affiliated health care providers. This individual serves as the primary liaison between Security Health Plan (SHP) and affiliated providers for escalated and contractual issues across various lines of business, with limited supervision. The Provider Relations Specialist is responsible for relationship management activities for hospital, professional, vendor, care system and/or ancillary providers including: development and execution of issue escalation strategies, educational programs, onsite visit criteria, special initiatives, and building and preserving strong provider relationships
JOB QUALIFICATIONS
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: Associate degree or 60+ credits in health care, business, marketing, education, or related field.
Preferred/Optional: Bachelor's degree in business administration, accounting, health care, finance, or related field.
EXPERIENCE
Minimum Required: Three years’ experience in a medical group practice or health insurance/Health Maintenance Organization (HMO) environment. Experience with healthcare claims and insurance reimbursement methods, and understanding of contract terminology. Working knowledge of health care delivery systems and concepts of managed care. Demonstrated proficiency with the Microsoft Office suite. Excellent written and verbal communication skills. Demonstrated ability to take initiative, utilize critical thinking, and bring forth solutions to identified issues.
Preferred/Optional: Experience in provider relations, including well-defined communication skills and a demonstrated aptitude for communicating with both business users and technical staff. Strong interpersonal, problem solving and relationship building experience. Credentialing or claims experience preferred.
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: None
Preferred/Optional: None
Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.
At Marshfield Clinic Health System, we are fully committed to addressing health equity, diversity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every individual should have the opportunity to attain their highest level of health. We embrace diversity and welcome differences in who we are and how we think. We believe that any individual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here.Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.
Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.