Provider Relations Representative

Banner Health - Mesa, AZ3.8

Full-time
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At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the health care experience the best it can be! Our team has come together with a common goal: Make health care easier, so life can be better. The future of health care starts here.

Banner has a great opportunity for a Provider Relations Representative. The Neighborhood Physician Alliance serves our independent physicians in the valley. If you want to be part of a team who’s excited about the positive changes in healthcare, especially the transition to value-based care, this is the position for you!

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options, so you can focus on being the best at what you do and enjoying your life.

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About Banner Health Network & Banner Plan Administration
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

About Banner Health
Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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Job Summary

This position responds to and resolves advanced to complex level issues related to the daily administration and operation of potential and existing providers and may involve provider education, interpreting and developing policies, procedures and guidelines. Provides in-service to appropriate personnel in regard to changes and updates in system support files.

Essential Functions

Travels frequently to physicians offices doing site visits, educating office staff, recruiting new offices, and resolving established problems.

Provides education to physicians and their office staff. This includes, but is not limited to coordinating orientation and education of providers, hospitals and the organizations insurance plan administration staff.

Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues.

Maintains all levels of communication with network providers, informing them of any operational, procedural, and contractual changes and updates.

Assists internal departments in resolving provider and member appeals pertaining to the organizations physician, hospital, and insurance plan contracts.

Assists manager with network development in various geographic regions within the organization, negotiates, implements and maintains managed care contracts with payers and providers.

Minimum Qualifications

Must possess a strong knowledge of healthcare as normally obtained through the completion of a bachelors degree in business, healthcare administration, or related field.

Must have an excellent understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding.

Must know how or learn to program data retrieval utilities and queries. The incumbent must possess the ability to track and analyze statistical data. This position requires a mathematical aptitude, computer experience, typing skills and the ability to work on a variety of projects in an organized fashion.Must have the ability to effectively communicate both verbally and in writing.

Preferred Qualifications

Three years of experience in the healthcare field preferred. Two years of medical claims auditing experience is preferable.

Additional related education and/or experience preferred.