Sr. Provider Relations Liaison

Kelsey Seybold Clinic Pearland, TX
Overview

Sr. Provider Relations Liaison

Location: Pearland Administrative Office

Department: Mgd Care Communications

Job Type: Full Time

COMPANY PROFILE

Kelsey-Seybold Clinic. Your Doctors for Life.

Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor. Kelsey-Seybold is Houston's largest community-based physician group, caring for more than 400,000 patients. With 19 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.

JOB SUMMARY

The Senior Provider Relations Liaison is responsible for establishing and maintaining strong positive business relationships with current and potential Kelsey-Seybold and KelseyCare Advantage affiliate and employed providers to ensure stable and geographically disperse networks for the Kelsey-Seybold commercial and Medicare Advantage health plans and KS Plan Administrators' health plan products. Responsibilities include providing educational instruction and support to physicians and their staff. The Senior Provider Relations Liaison will be the main point of contact for the respective providers and will routinely visit physician's offices for issues concerning the achievement of provider satisfaction, medical cost targets, network growth and/or efficiency targets. This role includes responsibility for education of the physicians and office staff on health plan products and benefits, policy and procedure for multiple managed care plans, assistance with claims payments and other duties as assigned. Travel requirements – local and extensive.

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

(A = basics; B = preferred)

Education

A.

Bachelor's Degree (1-year experience equivalent to 1 year of college)

5+ years' experience in applicable healthcare administrative operations.

Experience

A.

5+ years contract negotiation experience at a health plan or medical group.

5+ years' experience in provider relations or network management with a demonstrated ability to perform network development and/or provider relations.

Experience with developing provider and/or facility networks. Must possess a knowledge of claims processing, managed care plan benefits and utilization management policies and procedures.

Demonstrated negotiation skills and ability to interpret provider contracts and regulatory contracts.

3+ years of experience in Medicare/Commercial products

Licenses

A.

Valid Texas Driver's License and ability to travel. Must own or lease a working vehicle and be able to travel daily within the Greater Houston area.

Special Skills

A.

Demonstrated knowledge of CPT and ICD-10 coding and prior experience with reimbursement methodologies

Proficient with Microsoft Word and Excel

Analytical and problem-solving skills; ability to communicate effectively in writing and verbally

Proficient with Excel and/or PowerPoint

Other

A.

Ability to work in a fast-paced environment; demonstrated ability to perform multiple concurrent tasks with minimal supervision and meet deadlines

Demonstrated public speaking and presentation skills

Capable of managing a variety of complex issues while driving momentum of key projects

WORKING ENVIRONMENT

Office