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Provider Contracting Representative

Company: Employee Benefit Management Services, Inc.
Location: Billings
Posted on: January 15, 2020

Job Description:

Job Summary:This position is responsible for a full range of provider relations and interactions including coordinating and driving the most beneficial contracts for EBMS clients. This position will be primarily responsible to drive financial savings, create strong provider relationships and work on behalf of our client with integrity, commitment and innovation. Essential Duties and Responsibilities:Contracting Responsibilities

  • Assists with recruitment and negotiation of new provider contracts. Works with clients, providers, Account Managers and brokers on contract language and rate negotiations for Single Case Agreements and Contracts. Follows through with contact implementation and retention of records per current procedure.Reviews and analyzes billing rates to derive an appropriate fee schedule for a given area or provider. Performs analysis and maintenance of existing contracts.Reviews contracts for language compliance and possible rate deficiencies.Renegotiates as needed.Administrative DutiesProvides assistance to the Director of Provider Relations as needed.Fields and responds to requests and inquiries from providers, clients, brokers, and vendors.Collaborates cross-functionally on complex issues to ensure that provider needs are met and issues are resolved.Gathers data for research, problem solving, and other miscellaneous purposes.Produces, analyzes and disseminates reports as needed.Performs clerical functions as assigned.Customer Service
  • Provides timely and thorough follow up with staff, internal and external customers.Appropriately escalates difficult issues up the chain of command.Acts as a role model in demonstrating the core values in customer service deliveryProvider direct guidance and support to internal and external customers for EBMS' cost containment strategies. Assists with marketing and sales calls. Attends conferences and continuous education events.Quality Assurance
  • Serves on committees, work groups, and/or process improvement teams to assist in improving quality/customer satisfaction.Recognizes and alerts appropriate supervisor of trends that fall outside of quality parameters.Performs self-quality monitoring in order to develop and execute plans to meet established goals.Provides ongoing feedback to help optimize quality performance.Collaborates with others and cross-departmentally to improve or streamline procedures.Develops new or improves current internal processes to improve quality.This job description in no way states or implies that these are the only duties to be performed by this employee. The employee will be required to follow any other instructions and to perform any other duties requested by his/her supervisor.Minimum Qualifications:
Bachelor degree in healthcare or related field required Minimum of two years of medical billing and coding experience, medical office management and/or previous negotiations or contracting experience
Medicare experience preferredWorking knowledge of health benefit plans preferredWorking knowledge of computer software including but not limited to Microsoft Office products required Advanced Microsoft Excel skills preferred Demonstrated organizational skills, problem-solving, analytical skills and detail oriented Strong written and oral communication skillsDemonstrated ability to work independently, prioritize workloads, multi-task and manage priorities in order to meet deadlinesPhysical Demands & Working Conditions:Work is indoors in an office environment with moderate noise. Intermittent physical effort involving lifting of up to 25 pounds, walking, and stooping, kneeling, crouching, or crawling is required. A typical workday involves sitting, frequent use of a keyboard, reaching with hands and arms, and talking and hearing, approximately 70% of the time. Approximately 30% or less of the time is spent standing. Normal vision abilities required, including close vision and ability to adjust focus. Approximately 30-50% of time traveling is required.

Keywords: Employee Benefit Management Services, Inc., Billings , Provider Contracting Representative, Other , Billings, Montana

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