• Network Representative II

    Req No.
    2018-3523
    Company
    Sendero Health Plans
    Job Locations
    US-TX-Austin
    Category
    Administrative
    Type
    Regular Full-Time
  • Overview

    Under general supervision, is responsible for recruiting, contracting and servicing assigned providers within the Sendero Health Plans (Sendero) service area. Educates and services physicians, hospitals and ancillary providers within established guidelines. This position works closely with other health plan staff including Medical Management, Customer Service and Community Relations as well as with outsource vendors.

    Responsibilities

    • Recruit and contract assigned physicians and ancillary providers
    • Gather credentialing information for new physicians and assuring provider directory accuracy for assigned providers
    • Conduct new provider orientations and follow-up in-service training
    • Maintain open communications with providers on health plan issues related to claims, eligibility, utilization management, reimbursement and quality programs
    • Maintain strong working relationships with local hospitals, physicians, ancillary providers and their office staff to assure provider satisfaction
    • Resolve provider and member specific issues related to claims, eligibility and referrals.
    • Performs other duties as assigned.

    KNOWLEDGE, SKILLS, AND ABILITIES


    Knowledge of:

    • Medical care delivery and local market dynamics.

    Skill in:

    • Interpersonal skills and tracking of conflict resolution 
    • Developing problem solving skills with effective follow through
    • Strong listening, verbal, presentation and written communication skills
    • Word, Excel, Power Point and use of the internet

    Ability to:

    • Interface effectively both externally and internally with a wide range of people including physicians, office staff and other health plan staff.
    • Work independently with minimal supervision

    Qualifications

    MINIMUM EDUCATION:  College degree or equivalent years of work experience in related field.

     

    MINIMUM EXPERIENCE:  Experience in related field.

     

    PREFERRED EXPERIENCE:  Face-to-face sales or customer service experience is preferred. Professional provider relations experience involving physicians and administrative staff is strongly preferred.

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