Physician Relationship Management Specialist

Job Description

Coordinates and facilitates physician enrollment and network participation activities for various network products and Independent Practice Association (IPA). Acts as liaison between physicians, third-party insurance administrators, and departmental staff providing operational support. Works to ensure high-level customer service and physician satisfaction.

Job Responsibility

• Responds to various inquiries from participating physicians, network staff, hospital staff, and managed care companies.
• Resolves issues related to credentialing, managed care participation, claims payment, demographic changes, referrals, and accessibility.
• Responds to physician requests, provides updates and resolves issues.
• Coordinates and implements credentialing activities to assist providers with the completion of applications for network contract offerings; monitors applications and follows-up as needed.
• Conducts provider and facility credentialing and re-credentialing activities; communicates with providers to obtain requisite credentialing information to facilitate timely completion and submission of required documents.
• Facilitates re-credentialing requests and coordinates site visits related to managed care contracts.
• Prepares and reviews physician membership applications; verifies credentialing materials and enters into database.
• Communicates with providers regarding network provider enrollment policies, procedures and contractual obligations.
• Maintains provider files, as well as availability and contract-specific sentinel events.
• Assist with coordination, education and outreach; participates in community events.
• Contributes to network development by working as a key team member to build infrastructure, identify resources, and assist in operational plans.
• Implements projects and facilitates directives assigned by senior leadership; collaborates with network staff to facilitate operations.
• mentioned here, but considered related are not essential functions.
• Operates under general guidance and work assignments are varied and require interpretation and independent decisions on course of action.
• Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.

Job Qualification

• Bachelors Degree required, or equivalent combination of education and related experience.
• 1-3 years of relevant experience required.
• Bilingual, preferred.
• Strong relationship-building experience preferred.
• Position is field-based, primarily in New Jersey
• Additional Salary Detail

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team members base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).