Healthcare Representative

  • location: Independence, OH
  • type: Contract
  • salary: $18.15 per hour
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job description

Healthcare Representative

job summary:
JOB SUMMARY

  • Manages physician network by developing and maintaining relationships to drive business results within a specific geographic area.
  • Provides service and education to network physicians/providers.
  • Achieves company targets through implementation of Network Improvement plans.
ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities

  • Completes new provider orientation for all applicable product lines.
  • Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information and review HEDIS information.
  • Achieves call reach and frequency goals to establish consistent and strong relationship with provider offices.
  • Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.
  • Supports regional Network Improvement Plan targets by providing utilization reports pharmacy profiles ER contingencies.
  • Frequent Flier Reports and other analytics available to improve /maintain regions.
  • Identifies network gaps and completes contracts or works with Network Development.
  • Understands and explains risk contracts.
  • Strategies for membership growth and retention.
  • Provides oversight of delegated functions as applicable.
  • Performs special projects as assigned.
Additional Position Responsibilities - Optional

MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred

A Bachelor's Degree in a related field Required or equivalent work experience

Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred

  • 1+ year of experience in Medicare/Medicaid Preferred
  • Other Pharmacy. healthcare. provider or HMO/PPO background Preferred
  • No Experience Required
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred

Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

  • Demonstrated interpersonal/verbal communication skills Intermediate
  • Demonstrated written communication skills Intermediate
  • Demonstrated problem solving skills Intermediate
  • Demonstrated organizational skills Intermediate
  • Demonstrated time management and priority setting skills Intermediate
  • Demonstrated analytical skills Intermediate
  • Demonstrated customer service skills Intermediate
  • Ability to represent the company with external constituents Intermediate
  • Ability to work independently Intermediate
  • Demonstrated negotiation skills Intermediate
  • Ability to multi-task Intermediate
  • Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred
  • Microsoft Excel Intermediate Required
  • Microsoft Outlook Intermediate Required
  • Microsoft Word Intermediate Required
Languages ---- List all that apply ---- Languages Other Languages Required/Preferred

 
location: Independence, Ohio
job type: Contract
work hours: 8 to 5
education: Bachelor's degree
experience: 1 Years
 
responsibilities:
ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities

  • Completes new provider orientation for all applicable product lines.
  • Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information and review HEDIS information.
  • Achieves call reach and frequency goals to establish consistent and strong relationship with provider offices.
  • Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.
  • Supports regional Network Improvement Plan targets by providing utilization reports pharmacy profiles ER contingencies.
  • Frequent Flier Reports and other analytics available to improve /maintain regions.
  • Identifies network gaps and completes contracts or works with Network Development.
  • Understands and explains risk contracts.
  • Strategies for membership growth and retention.
  • Provides oversight of delegated functions as applicable.
  • Performs special projects as assigned.
Additional Position Responsibilities - Optional

MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred

A Bachelor's Degree in a related field Required or equivalent work experience

Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred

  • 1+ year of experience in Medicare/Medicaid Preferred
  • Other Pharmacy. healthcare. provider or HMO/PPO background Preferred
  • No Experience Required
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred

Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

  • Demonstrated interpersonal/verbal communication skills Intermediate
  • Demonstrated written communication skills Intermediate
  • Demonstrated problem solving skills Intermediate
  • Demonstrated organizational skills Intermediate
  • Demonstrated time management and priority setting skills Intermediate
  • Demonstrated analytical skills Intermediate
  • Demonstrated customer service skills Intermediate
  • Ability to represent the company with external constituents Intermediate
  • Ability to work independently Intermediate
  • Demonstrated negotiation skills Intermediate
  • Ability to multi-task Intermediate
  • Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred
  • Microsoft Excel Intermediate Required
  • Microsoft Outlook Intermediate Required
  • Microsoft Word Intermediate Required
 
qualifications:
Additional Position Responsibilities - Optional

MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred

A Bachelor's Degree in a related field Required or equivalent work experience

Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred

  • 1+ year of experience in Medicare/Medicaid Preferred
  • Other Pharmacy. healthcare. provider or HMO/PPO background Preferred
  • No Experience Required
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred

Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

  • Demonstrated interpersonal/verbal communication skills Intermediate
  • Demonstrated written communication skills Intermediate
  • Demonstrated problem solving skills Intermediate
  • Demonstrated organizational skills Intermediate
  • Demonstrated time management and priority setting skills Intermediate
  • Demonstrated analytical skills Intermediate
  • Demonstrated customer service skills Intermediate
  • Ability to represent the company with external constituents Intermediate
  • Ability to work independently Intermediate
  • Demonstrated negotiation skills Intermediate
  • Ability to multi-task Intermediate
  • Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred
  • Microsoft Excel Intermediate Required
  • Microsoft Outlook Intermediate Required
  • Microsoft Word Intermediate Required
 
skills: Other
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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