Provider Relations Specialist
MTI America is a Medical Solutions Company that offers a collaborative, engaging and energetic work environment where people feel part of a family. Our core values—Excellence, Compassion, Communication, Integrity and Teamwork—guide us daily to work hard and enjoy what we do! We’re committed to growing our company and are always looking to promote from within. This is an ideal time to join our team!
MTI is a network provider of comprehensive, healthcare solutions delivering decades of value to third party administrators, insurance carriers and employers in the workers compensation industry. Our innovative transport, on demand interpreting, diagnostics, physical medicine and dental & hearing programs keep employers’ costs down while streamlining service delivery for the injured employee, claims professional and providers. Service is our priority.
The Provider Relations Specialist is responsible for Provider and Network performance across the Specialty Provider Network. He/She manages provider implementation and cost, as well as all duties including recruitment, training, credentialing, and audits. This includes working with various departments in partnership to assure the success of our providers and overall operations.
- Acts as the liaison between providers, patients, clients and corporate.
- Investigates, researches and resolves provider claims issues.
- Conducts training, orientation and coaching for performance improvement within provider offices.
- Educates providers regarding policies and procedures related to referrals, reporting, and claims submission and problem solving.
- Provides account management, builds and maintains positive relationships with providers by offering excellent customer service to provider/vendors, with routine and targeted education for the purpose of continued education regarding policies/initiatives.
- Follows up regarding claims, and procedural guidelines for authorization of services.
- Conducts interaction with the providers documenting discussions, issues, attendees, researching claims issues and routing to the appropriate party for resolution.
- Creates, manages and edits provider profiles.
- Performs provider credentialing activities to ensure compliance with MTI America’s policy and procedure.
- Reviews contract terms and conditions to ensure compliance with federal and state laws and company policies.
- Evaluates or monitors contract performance to determine the necessity for amendments or extensions of contracts, and compliance to contractual obligations.
- Analyzes provider cost data to identify providers or areas for improvement and contracting.
- Authorizes policy/procedure and other supporting documentation, workflow to improve requests and oversees testing completion.
- Performs provider orientations, including writing/updating orientation material when necessary.
- Other duties as assigned.
Skills and Expertise:
- Bachelor’s degree in business or related discipline preferred.
- 3+ years’ experience in network development in healthcare required; workers’ compensation preferred.
- Experience in Provider Relations, project management and contract negotiations highly desirable.
- Experience in Cost Management is preferred.
- Ability to maintain a high level of confidentiality.
- Good understanding of ancillary products and services.
- Knowledgeable of contract negotiation principles.
- Excellent verbal and written communication skills to technical and non-technical audiences of various levels in the organization (e.g. executive, management, individual contributors).
- Excellent problem solving, team and time management skills managing multiple deadlines for self and others.
- Proficiency to operate independently on work that is often confidential in nature.
- Proficient in Microsoft Office Suite required.
- Strategic thinker and persuasive negotiator skills preferred.
- Must be able to conduct inspections, audits, communicate issues, and corrective actions from an authoritative position but with professional courtesy.
- Analytical in using data to drive operational and cost improvement
- High School Diploma or equivalent required. College degree preferred.
Physical Demands/Work environment:
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Individuals may need to sit or stand as needed. May require walking primarily on a level surface for periodic periods throughout the day. Reaching above shoulder heights, below the waist or lifting as required to file documents or store materials throughout the workday. Proper lifting techniques required. On occasion, may include lifting of up to 5 pounds for files and computer printouts.
- For roles located in the field; this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands, and fingers speak, and hear.
- Hearing, vision, and talking. Specific vision abilities required by this job include ability see things from a close distance and ability to adjust focus.
- Utilizes fluorescent lighting; noise level is moderate. For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office.
The Job Description is subject to change at any time MTI America is an Equal Opportunity Employer and a Drug-Free Workplace. By submitting a resume for this position, you authorize MTI America to contact you via phone, email, or text message to coordinate an interview.