Provider Service Specialist - Care N’ Care (CNC) - Health Plan, SWHR at Southwestern Health Resources CIN in Pittston, Pennsylvania

Job Description:

Provider Service Specialist

Care N' Care (CNC) - Health Plan

Southwestern Health Resources, a national leader in population health, is looking for a qualified Provider Service Specialist - Care N' Care (CNC) to join our Health Plan team.

If you're looking for a rewarding career at a patient-centered organization with work-life balance and comprehensive benefits, we want to hear from you.

Position Highlights

Work location: Southwestern Health Resources Headquarters, 1601/1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.

Work environment: Health Plan.

Please note: The Provider Service Specialist - Care N' Care (CNC) will be an employee of Southwestern Health Resources (SWHR). SWHR is a clinically integrated network formed by Texas Health Resources (THR) and University of Texas Southwestern Medical Center (UTSW).

Work hours:

• Full-time, 40 hours per week.
• Monday - Friday, Day shift.
• This is a Hybrid position, requiring onsite workdays based on department business needs.
• Require in-person attendance as needed, to department meetings, trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management.
• May require travel within the Dallas/Fort Worth Metroplex and surrounding areas, based on department business needs.

Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health Resources and University of Texas Southwestern Medical Center, two of the region's leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas.

The SWHR Network includes physicians from University of Texas Southwestern Medical Center and Texas Health Resources, as well as more than 2500 independent community Primary and Specialty Care Physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, across 16 counties in North Texas, resulting in lower costs and high-quality care.

In 2020, the Centers for Medicare & Medicaid Services (CMS) released the annual financial and quality results. Based on the report, SWHR is one of the nation's leading Next Generation Accountable Care Organizations (ACO), having saved nearly $120 million since joining the program in 2017.

SWHR is the parent organization of Care N' Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.

Education

• High School Diploma or equivalent required.
• Bachelor's Degree in Healthcare, Marketing, Communications, Public Relations, Business, or relevant area of study highly preferred.

Experience

• Require 2 years' experience in Healthcare, Managed Care, Health/Medical Insurance, Provider Relations or Provider Account Management.
• Prefer 1 year of Medicare Advantage experience.
• Prefer 1 year of Medical Claims Billing and/or Coding knowledge.

Licenses & Certifications

• Driver's License upon hire required.

Skills & Abilities

• Demonstrate a general knowledge of healthcare delivery systems.
• Able to interpret reports, prioritize assignments, evaluate the accuracy of data, and effectively communicate results.
• Ability to create action plans to support the reports to drive results.
• Must be able to multitask, participate in projects, identify priorities, problem solve, make decisions, organize, and analyze workflow, write, plan, use math method formulas, and simple arithmetic.
• Ability to communicate professionally in writing and verbally with internal and external customers.
• Creative in developing education materials for providers; Able to develop and maintain provider partnerships for the health plan.
• Ability to exhibit confidence when working directly with physicians and their staff.
• Flexible schedule and availability to attend business meetings.
• Must be able to operate general office equipment including but not limited to computer, phones, related media, and information devices.
• Possess intermediate knowledge of Microsoft Word, Excel, Power Point, Qnxt, Facets, Ring Central and Salesforce.
• Dependable, self-motivated, creative, solution focused and exhibits initiative.
• Remain composed in emotionally stressful situations at all times.
• Ability to work well on a team and independently.
• Must be able to provide excellent customer service to internal and external customers
• Must have reliable transportation and driver's license.

Position Responsibilities

The Provider Service Specialist is the primary liaison between the health plan and the participating network providers within service area. Provider Service Specialist builds and maintains partnerships with providers and their staff. Provider Service Specialist contributes to excellent customer service in providing guidance, training, resources and attends to provider inquiries/concerns in a timely manner. Participates with other departments as needed to resolve any provider concerns. Remains in contact with providers via telephone, written communications, conducting webinars and on-site provider visits (when permitted). Collaborates with RAF and Quality for health plan provider project initiatives.

Position Functions

Establish and maintain strategic partnerships with providers. Communicates the vision and goals of the health plan to support the development of the highest possible provider partnerships:

• Collaborate with providers, especially primary care, and their staff to ensure their practice improves their RAF and Quality results.
• Explain reports to providers and their staff that directly drive results related to health plan initiatives.
• Shares best practices with providers exercise of discretion, judgment and make recommendations for actions that will drive results.
• Create partnerships with IPA's to maintain open communication with extended providers.
• Flexible schedule and availability to attend business meetings.
• Provide professional, timely and accurate direct customer service to internal and external customers.

Provide Customer Service to Providers:

• Provide health plan updates, education, resources, training, guidance to providers and their staff.
• Be creative, contribute to developing, implementing provider education materials and resources.
• Attend to provider issues/concerns in a timely manner.
• Conduct health plan Welcome Orientations to new providers plus their staff.
• Be the primary contact for participating providers in the network.
• Strive for provider satisfaction with health plan overall.

Resolve complex provider issues:

• Identify issues and how it may affect other health plan department operations.
• Contribute to identifying the root cause, problem solve, make decisions, interpret data, organize, and analyze.
• Escalate any trends identified and share findings with department.
• Collaborate with other departments to address any complex issues to resolve them in a timely manner.
• Maintain open communication with providers on status of their issues.

Track and document daily activities in a timely manner:

• Document in systems daily activities and communication with internal/external customers accurately, timely and clearly.

Participate with other departments on health plan initiatives to improve provider performance:

• Contribute to creating provider education materials and resources.
• Getting providers to actively participate in health plan programs/projects.
• Coordinate with provider offices to review reports.

Why Southwestern Health Resources

As a Southwestern Health Resources employee, you'll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Additional perks of being an SWHR employee:

• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients' quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org

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