Provider Relations Coordinator

Location:

Calmont Operations Building

Department:

Network Mgmt

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The Provider Relations Coordinator serves as the primary liaison between Cook Children's Health Plan and its contracted physicians, hospitals, ancillary providers, and provider office staff. This field-based position is responsible for conducting onsite provider orientation, education, training, and relationship management activities to support provider engagement, operational excellence, quality improvement, and regulatory compliance. The Coordinator travels throughout assigned service areas to provide in-person education, deliver provider performance scorecards, resolve operational issues, communicate health plan initiatives, and ensure providers have the tools and resources necessary to successfully participate in the provider network. This role requires a highly motivated, professional, and outgoing individual with strong presentation skills, knowledge of Texas Medicaid and CHIP, and the ability to build effective provider relationships.

Additional Information:

The Provider Relations Coordinator is responsible for performing all physician, hospital and ancillary provider orientation, training and ongoing educational activities for CCHP network providers and their staffs. Responsible for the tracking of concerns, complaints and issues raised by network providers, and results reporting. Facilitates resolution of all complaints/issues raised by network providers related to members, claims, operational policies and organizational procedures. Responsible for ensuring the accuracy and completeness of CCHP provider directory information. Coordination of the development and publication of the CCHP provider newsletter. Development & maintenance of the CCHP provider reference guide. Develops and implements additional communications required to assure that CCHP providers are knowledgeable regarding CCHP operations and programs.

Education & Experience:

• •High School graduate with advanced training in healthcare, business, or a related field required.
• •Five (5) years of operational experience in a managed care organization specifically in the area of provider network management to include provider orientation, ongoing educational activities, problem resolution and provider communications required .
• •Previous experience with face-to-face visits to provider offices and traveling to designated providers offices based on territory assignments/counties required.
• •Experience preparing and presenting information to individuals and groups.
• •Experience with governmental managed care programs desired.

Knowledge, Skills & Abilities:

• •Incumbent must demonstrate proven success in establishing and maintaining positive working relationships with health care providers and their staffs.
• •Working knowledge of HMO business operations specifically the functions of utilization management, member services, claims, credentialing and benefit plan interpretation.
• •Must be attentive to detail, have excellent organizational, problem solving, verbal and written skills.
• •Must be able to work independently and actively participate as an integrated team member.

About Us:

Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

Cook Children’s is a Texas-only employer. If you are hired, you will need to maintain your primary residence within the state of Texas, along with all licenses and credentials required for your position throughout your employment.