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Provider Relations Specialist - Full Time Days - Immanuel Home Office

Immanuel Omaha, NE
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Job Description

Purpose of the Job: 

Develops and maintains contractual relationships with service providers for Immanuel Pathways, ensuring that providers understand the role and responsibility and maintain ongoing compliance as required by PACE regulations. Supports and lives out Immanuel’s Mission and CHRIST Promises.

KEY RESPONSIBILITIES

Key Areas

Key Responsibilities and Duties of the Job

75%  Contract Administration

  • Develops contractual relationships with service providers, confirming and/or questioning rates, drafting contract agreements, and maintaining the required PACE provider network.
  • Coordinate and monitor semi-annual quality on-site reviews of all contracted providers and accountable for OIG checks semi-annually.
  • Coordinates and completes HIPAA business agreements, with providers as appropriate or requested.
  • Conducts appropriate follow-up with pending providers to ensure timely implementation of contracts,
  • Provides the initial provider orientation training to all contracted providers. Ensures documentation of training and proper filing of information for annual PACE audit.
  • Ensures audit checklist is completed following the implementation of all contracts.
  • Provides updated annual training material to contracted providers.
  • Manages provider network as the contract liaison to address provider\Immanuel Pathways concerns in a timely and efficient manner.
  • Provides, at a minimum, quarterly communications to all contracted vendors related to organizational updates, satisfaction survey results, invoicing updates etc.
  • Interfaces with organization’s departments and maintains a provider database to communicate appropriate contract information, including responsibility for updating provider information in the PACE Organizations consolidated managed care system. 
  • Communicate contracted vendor status changes to Executive Director, Medical Director and IDT in a timely manner.
  • Communicate contracted vendor contract revisions to Executive Director, Medical Director and IDT in a timely manner.

25% Compliance

  • Ensures contract compliance with State and Federal regulations.
  • Maintains compliance with established departmental and organizational policies, procedures and objectives.
  • Follows all Immanuel Pathways policies and procedures and OSHA safety guidelines.
  • Participates in all safety, security and infection control programs that are mandatory as well as those required and provided by Immanuel Pathways-PACE.
  • Maintains and promotes a professional attitude by providing safe and effective support and assistance to co-workers in the delivery of participant care
  • Maintains the confidentiality of all company procedures, results, and information about participants and staff including faxed information and courier materials.
  • Maintains safe working environment. Follows all fire and safety guidelines.
  • Participates in continuing education classes and any required staff and training meetings.
  • Participates in PACE Center QAPI Plan.

Other

  • Performs other duties as required or requested.
  • Maintains professional affiliations and any required certifications.

QUALIFICATIONS

Education-

  • Post high-school education is required.
  • Bachelor’s degree in business administration, marketing or related field is preferred.

Experience-

  • One (1) year experience working with the frail or elderly population is required.
  • Two (2) years in higher level administrative job, preferably in the healthcare industry.
  • Equivalent years of education may substitute for experience requirement.

Other Requirements-

  • Must have medical clearance for communicable diseases and up-to-date immunizations before having participant contact.
  • Must have a valid driver’s license, proof of insurance and have means of transportation.
  • Basic Life Support (BLS) Skills i.e. Health Care Level Cardiopulmonary resuscitation (CPR); Automated External Defibrillator (AED); First Aide (FA).

KSA-Knowledge, Skills, Abilities-

  • Knowledge of professional and institutional medical contracts including their coding preference, credentialing, and regulatory statutes preferred.
  • Knowledge of safety, privacy and compliance requirements for healthcare facilities.
  • Word processing skills, data collection skills and knowledge of basic statistical principles.
  • Skilled in identifying and recommending problem resolution.
  • Skilled in written and oral communication.
  • Skilled in utilizing software applications
  • Ability to apply and adapt skills and knowledge acquired through training and development opportunities.
  • Ability to establish and maintain effective working relationships with outside medical vendors and coordination of their activities with internal departments.
  • Ability to confer and consult to obtain effective, code definable and regulatory compliant contracts with both professional and institutional vendors on behalf of Immanuel Pathways PACE Centers.
  • Must have the ability to navigate through contracts and manage outside vendor contracts and maintain them in consolidated managed care system.
  • Ability to coordinate all credentialing activity within the PACE center and between contracted vendors and internal and external credentialing review entities.
  • Ability to chart via Electronic Health Records
  • Proven experience and basic computer proficiency (internet, email, Microsoft Office)

Job Details

Date Posted December 31, 2018
Date Closes May 14, 2019
Located In Omaha, NE
Job Type Full-time Employee
Experience Level Entry Level (0-2 yrs. experience)
Hours 40 hours per week; Days
Start Date Immediately
Positions Available 1
SOC Category 43-4199.00 Information and Record Clerks, All Other
Zipcode 68154
Name Traci Soliz
Address 1044 N 115th Street, Suite 500
City, State and Zip Omaha, NE 68154

This job offers the following benefits

  • 401(k) Retirement Savings Plan
  • Dependent-Care Spending Accounts
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Accidental Death and Dismemberment
  • Dental
  • Dependent Life Insurance
  • Employee Assistance Program (EAP)
  • Group Legal
  • Life Insurance
  • Long-Term Disability
  • Medical
  • Prescription Drug Plan
  • Short-Term Disability
  • Vision
  • Voluntary Life Insurance
  • Adoption Assistance
  • Bereavement Pay
  • Continuing Education Program
  • Discounts on Employer Merchandise & Services
  • Employee Referral Program
  • Fitness Classes
  • Free Parking
  • Paid Holidays
  • Paid Vacations
  • Tuition Reimbursement
  • Wellness Program
  • Workout Facilities
  • Merit Increases
At a Glance
Enjoy these benefits
  • 401(k) Retirement Savings Plan
  • Dependent-Care Spending Accounts
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Accidental Death and Dismemberment
  • And More ...
Location