Provider Representative

Summary/Position Objectives:
This position acts as a representative for Mercy Care Plan (MCP) and is the liaison between MCP and the provider community. This position is responsible for training, maintaining and strengthening the provider network in accordance with the AHCCCS Acute, ALTCS, DD, HCG, and Medicare lines of business. This position provides onsite provider training, problem identification and resolution, evaluation of provider network as indicated. This position works as a team member with providers, provider’s office staff and all departments within MCP, Schaller Anderson, Inc. and affiliates.

Responsibilities:
Essential Functions:
Provides onsite support, training and continuing education to contracted primary care physicians, specialists, dentists, skilled nursing facilities, home and community based providers and any other contracted provider as assigned.
Acts as intermediary between the Plan and providers to actively research and resolve provider complaints and issues, i.e. claims, negative balances, and respond to correspondence.
Maintains positive relationships with the provider community, both contracted and non-contracted providers.
Conducts pre-contracting, tri-annual, monthly and quarterly visits as required.
Completes documents substantiating visits in a timely manner and ensures documents are placed in providers files.
Reports to management changes within the provider network.
Promotes and assists with Electronic Data Interchange (EDI) setup Medifax and Electronic Funds Transfer (EFT) set up, as well as Secured website portal agreements.
Ensures Providers submit accurate and up to date 1099’s.
Completes system configuration requests for all provider network changes and modification and ensures compliance with AHCCCS technical requirements for reporting and encounter submission.
Responsible for ensuring the accuracy and timeliness of the contract files.
Conducts accessibility monitoring of contracted providers.
Reviews monthly AHCCCS plan packet and ensures provider changes are submitted to the PIM department in order to maintain data integrity

Secondary Functions:
Follows and adheres to all MCP policies and procedures.
Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
Maintains regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.
Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs.
Performs other duties, assignments and responsibilities as assigned or required
REQUIREMENTS
Knowledge and Skills:
Familiarity of all MCP lines of business, including ALTCS and Mercy Care Advantage
Requires logic and understanding to analyze problems and determine appropriate course of action
Ability to handle multiple projects simultaneously
Ability to read, write and orally communicate at a level of correctly solicit/explain information
PC skills including various types of software applications.

Education and Work Experience:
A minimum two years experience as a provider service representative or equivalent experience in a health care environment.

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k)
* Tuition reimbursement
Visit www.schalleranderson.com for more information or submit a resume to [Click here for email]. EOE