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Provider Relations Rep, Pikeville Region

Company Name:
Aetna
Req ID: 15047BR
GENERAL SUMMARYWork from Home position with travel within the region required.Responsible for maintaining working relationships with the existing provider network. Assists providers with policy and procedure interpretation. Maintains accurate and current databases relating to provider facilities and physician information. May assist with physician recruitment.ESSENTIAL RESPONSIBILITIES - Maintains regular contact with key provider organizations and serves as a liaison to internally resolve complex issues. Develops strong interpersonal relationships with assigned providers. - Researches and resolves incoming escalated provider inquiries within contract guidelines. Educates providers on new protocols, policies, and procedures. - May assist with physician recruitment by identifying specific providers within a designated territory, facilitating the distribution of provider agreements, negotiating rates for new physicians, and renegotiating contracts for existing physicians within established limits. - May conduct provider office site visits to ensure site meets contract guidelines. - Ensures provider database and documentation is up-to-date, accurate, and complete. Ensures new physician contracts are entered promptly and accurately. - Assists with the development and implementation of provider training programs. - Performs other duties as required.JOB SPECIFICATIONS - Bachelor''s degree or equivalent experience. - Previous (3-5 years) customer service experience with exposure to benefits interpretation and provider networking. - Knowledge of managed care policy and direction, benefit plan design, and provider fee schedules desired. - Knowledge of ICD-9 and CPT codes desired. - Strong analytic and problem solving abilities. - Strong communication and negotiation skills.
Job Function: Health Care

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