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November 19, 2019  
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Provider Relations Specialist I

Position Description


Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices.

Serve as primary contact for providers serving as a liaison between the provider and the health plan

Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on

site and routing to the appropriate party for resolution

Receive and respond to external provider related issues

Initiate entry or change of provider related database information and oversee testing and completion of change request

Investigate, resolve and communicate provider claim issues and changes

Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving

Perform provider orientations, including writing and updating orientation materials

Ability to travel

Additional Information

Employment Type: Full-Time    
Position Location: Nashville, Tennessee

Apply For This Job: Provider Relations Specialist I


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