Sr. PC3 Field Operations Rep - (boston, massachusetts) in Boston, Massachusetts For Sale
Job Summary 13;
The Sr. PC3 Field Operations Representative maintains working relationships with internal departments and external customers. This position interacts with and provides support to Field Operations Management, who will be working directly with VA Medical Centers and facilities, to ensure delivery of quality services in a consistent and uniform manner across assigned market(s). This position will serve as a key source of VA Medical Center education individually, in groups and/or web:based. The Sr. PC3 Field Operations Representative is focused on customer satisfaction and education, assures compliance with contracts, performs research of unresolved or complex issues, and compiles necessary information/reports. This position reports to the PC3 Field Operations Manager.
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Essential Duties and Responsibilities 13;
:Assures compliance with respective contracts. Researches, analyzes and resolves claims, benefits, issues and authorization inquiries within delegated authority.
:Interprets Health Nets policies and procedures. Provides interpretation and clarification of benefits, eligibility, and access to care requirements. Escalates recurring or critical issues as appropriate to management.
:Assesses VA Medical Centers training needs. Develops, implements, and conducts appropriate training programs and/or orientations for assigned VA Medical Center staff
:Monitors provider database of current data relating to provider and physician information.
:Ensures provider directories are accurate.
:Answers Web/e:mail inquiries and correspondence from VA Medical Centers; Provides technical replies to VA Medical Centers regarding PCCC program requirements and processes; Makes outbound education calls to VA Medical Centers.
:Investigates compliance issues, identifies root cause, trains VA Medical Center office staff on correct procedures, and provides written reports of findings and recommendations.
:Meets on a regular basis in person or by telephone with assigned key VA Medical Centers to cultivate and strengthen relationships. Documents VA Medical Centers issues on shared drive log.
:Supports the retention of providers by participating in meetings, and conducting research.
:Assists management in tracking, trending and reporting on provider recruitment and retention.
:Provides support on special projects
:Performs other duties as assigned. 13;
Education 13;
:Bachelors Degree in Health Care Administration or related field preferred
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Certification/Licensure Required 13;
N/A 13;
Government Clearance and US Citizenship Requirement 13;
N/A 13;
Experience Required 13;
:Minimum three years experience in provider relations, provider contracting; health plan operations or health care/medical office environment
:OR
:Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
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Knowledge, Skills and Abilities 13;
:Ability to establish and maintain critical business and working relationships with VA Medical Centers
:Ability to maintain professional and technical knowledge of department procedures and technology.
:Ability to conduct group/individual VA Medical Center education presentations for new and existing VA staff and serves as a department subject matter expert.
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Working Conditions 13;
:The following section describes the general physical requirements for this position. Please note that constant refers to more than 81 of time; significant refers to 40:80; and moderate refers to 20:40 of the time.
:Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
:Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
:May be required to work outside of normally scheduled hours as mand
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