Provider Contracting Director is responsible for the operations of the provider contracts department. Ensures that provider contracts are processed to support accurate and efficient claims payments. Being a Provider Contracting Director oversees the formulation of provider contracts and specific terms. Analyzes contract data and provides financial projections. Additionally, Provider Contracting Director requires a bachelor's degree. Typically reports to top management. The Provider Contracting Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Provider Contracting Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
SUMMARY:
Provider Relations Specialist I
Responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment information to internal and external customers.
Provider Relations Specialist II
Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software and reference library to determine appropriateness of codes and excessive charges. Responsible for making coding determinations according to state rules and regulations.
PRIMARY RESPONSIBILITIES:
PRIMARY RESPONSIBILITIES: Provider Relations Specialist I
Additional responsibilities of Provider Relations Specialist II
This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS:
EDUCATION REQUIRED:
Provider Relations Specialists I
Provider Relations Specialists II
EXPERIENCE REQUIRED:
Provider Relations Specialists I
Provider Relations Specialists II
OR
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Provider Relations Specialists I
Additional Skills Required for Provider Relations Specialist II
ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:
WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards.
REQUIRED TESTING:
Proofreading, 10 Key, Math, Basic Windows, Reading Comprehension, Typing 40wpm, Intermediate Word, Intermediate Excel
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