Provider Relations Coordinator - Healthcare Network

Job Description

Job Description

Ohio Children's Alliance

Provider Relations Coordinator (Healthcare Network)

About Us:

Through its mission, the Ohio Children's Alliance fosters a brighter future for Ohio's children and families through advocacy, innovation, and collaboration with health and human services organizations.

Collaborate and advocate with great people! We are a team of talented and diverse people, who are passionate about building innovative solutions to challenges facing kids and families. With community agencies as our partners, we are empowering families to raise Ohio's next generation of leaders. Join us!

Role Overview:

Under the direction of the Director, Value-Based Care, this full-time position will be responsible for building and maintaining strategic relationships with current and prospective community mental health centers that participate in our Collaborative healthcare network. The Provider Relations Coordinator will serve as our primary liaison to over 40 Ohio-based community mental health centers. The coordinator will educate representatives of the centers on Ohio Medicaid health plan processes and policies, investigate and resolve provider claims and billing issues, and support centers on their participation in our healthcare quality initiatives and value-based performance programs.

Must reside in Ohio to qualify for consideration. (Central Ohio is preferred.) This position currently follows a hybrid work schedule with occasional in-person requirements, including weekly meetings, until further notice.

Key Responsibilities:

Under the direction of Director, Value-Based Care this individual will be responsible for building, nurturing and maintaining positive working relationships with agencies participating in the clinically integrated network and with payor partners

• Provide excellent provider-relations support
  • Educate providers regarding payor referral, prior authorization and claims submission policies and procedures as well as Child & Family Health Collaborative resources, payor education opportunities and other topics
  • Escalate credentialing and claims issues on behalf of member agencies and the Child & Family Health Collaborative respite program; follow-up to ensure resolution in a timely manner; document in Monday.com and provide regular updates to impacted agencies/programs
  • Work with providers to resolve ongoing rejection and denial issues (based on information provided by payors)
  • Update and distribute Behavioral Health Coding Workbook when Child & Family Health Collaborative-negotiated rates change and/or base Medicaid reimbursement rates change
• Provide excellent customer service to payor partners
  • Promptly follow-up on questions regarding agencies participating in the clinically integrated network
  • Ensure timely distribution of payor-provided information to agencies participating in the clinically integrated network
  • Work with payors to receive monthly payor claims metrics (e.g. rejections trends, rejection trends by provider, rejection trends by reason, rejection trends by reason by provider, denial trends, denial trends by provider, denial trends by reason, denial trends by reason by provider), so that the Collaborative may follow-up with providers
• Support quality improvement initiatives (specific tasks include, but may change over time)
  • Review and distribute monthly attribution rosters and quality measure performance reports
  • Follow-up with providers to offer education regarding reports, HEDIS and other quality measures; discuss measures in which the provider's performance is lower than payor targets and/or Collaborative averages; offer resources and other support to improve provider performance
  • Follow-up with payors regarding any provider-identified data inaccuracies or questions; follow-up to ensure resolution in a timely manner
  • Assist in the development of intervention toolkits; lead sessions with agencies to educate them on completed key driver diagrams and implementation of intervention toolkits
  • Assist in the development of best practice documents
  • Review monthly CliniSync activity reports
  • Follow-up with providers who are not meeting Collaborative expectations regarding CliniSync participation or utilization
  • Escalate CliniSync technical issues on behalf of member agencies and follow-up to ensure resolution in a timely manner; document in Monday.com
• Support payor contracting (specific tasks include, but may change over time)
  • Maintain and update participating provider information in Monday.com to ensure the Collaborative has correct information to share with payors
  • Obtain and maintain agency-specific credentialing information (e.g. ODI Standardized Credentialing Form Part B and attachments)
  • Complete agency-specific forms to add new providers to Collaborative agreements or existing clinically integrated network agencies to new agreements accurately, thoroughly and timely
• Problem solve and identify ways to address provider issues effectively
• Be highly motivated and able to work with multiple teams simultaneously
• Perform other duties assigned by the Director, Value-Based Care

Qualifications:

The ideal candidate will possess professional experience in healthcare and provider relations and will have the ability to manage project-related paperwork by ensuring all necessary materials are current, properly filed on our server, and organized. Further, the ideal candidate will have the ability to direct project correspondence by preparing and reviewing proposals, memos, meeting minutes, and emails.

• Education/Experience: associate's degree required; bachelor's degree in healthcare or business fields preferred
• 2+ years of healthcare provider relations, account management, or contracting experience
• A commitment to advancing equity, including in healthcare
• Understanding of HEDIS and other quality measures
• Knowledge of Ohio's Medicaid program, healthcare claims and coding, and community behavioral health preferred
• Excellent oral and written communication skills and attention to detail
• Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills, priority setting and problem-solving skills
• Proficiency with Microsoft Office 365 products (Outlook, SharePoint, Teams, Word, PowerPoint and Excel)

Why Join Us?

• Impactful Work: Be part of making a real difference in the lives of children and families across Ohio.
• Professional Growth: Opportunities for continuous learning and career advancement.
• Supportive Team: Work with a passionate and dedicated team committed to excellence.
• Flexible Environment: Enjoy a dynamic work environment with flexibility.
• Diversity: The Ohio Children's Alliance is an equal opportunity employer committed to fostering a diverse and inclusive workplace. We welcome and value the contributions of people from different backgrounds, cultures, identities, and experiences, and we strive to create a work environment where everyone can belong, thrive, and grow.

Join us in our mission to create a brighter future for Ohio's children and families. Apply today and be a part of something truly special!

A background check will be run prior to hire.