Senior Provider Service Specialist

Professional Health Care Network (PHCN) manages the home health benefit for major insurance plans with the focus on Medicare Advantage and managed Medicaid patients. We review home health care referrals for appropriateness and then set up services with multiple agencies to provide the care needed for patients. On an ongoing basis, we provide review and oversight of clinical care and determine further authorizations.

PHCN is looking for a detailed oriented self-starter to work directly with our National Director of Network Management to assist PHCN in providing exceptional quality care management of home health services. The Provider Service Specialist is responsible for analyzing and problem-solving potential issues raised by home health care agencies, referring providers, and insurance companies. Additionally, this position is responsible for building strong relationships with health plans, home health care agencies, and referring providers all while executing on the actions needed to ensure the network is engaged and capable of servicing PHCN’s patient population.

Job Responsibilities:

  • Build and maintain strong working relationships with participating providers and referral sources through effective customer service and outreach, which includes on-site and virtual visits
  • Problem solve issues raised by PHCN stakeholders, and communicate recommendations to address common issues
  • Ensure PHCN’s network of home health agencies operate in compliance with PHCN and Medicare guidelines, along with all State and Federal laws and regulations
  • Optimize the home health agency network by leveraging referring provider relationships, contracting opportunities, and other resources and means made available in a fiscally responsible manner
  • Carry out network management assignments and other duties as directed by the management team
  • Travel as needed

Ideal Candidate:

  • Help to create a challenging and fulfilling work environment while empowering others to deliver high quality customer service
  • Excellent interpersonal skills
  • Ability to facilitate strong communication between administrative staff, home health agency network and referral sources, in an effort to coordinate the best possible home care service outcomes
  • Ability to listen and communicate forward any potential issues experienced by PHCN stakeholders
  • Experience Must show proven ability to make thoughtful decisions in a timely manner and stand firm, as appropriate
  • Ability to travel as required both in and out of state

Requirements:

  • 3+ years experience servicing Network Management functions, which includes credentialing, contracting, or acting as a liaison/coordinator under provider network departments
  • Must have base-level knowledge of home health agency contract structure
  • Must have an understanding of home health agency credentialing process
  • Must be able to diffuse situations and work in a fast pace environment with deadlines
  • Proven ability to effectively problem solve and diffuse difficult situations in a timely manner
  • Able to build trust and assurances with various partners and stakeholders both externally and internally
Job Category: Network
Job Type: Full Time
Job Location: Phoenix Office Remote

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