**Hours of Work :** **Days Of Week :** **Work Shift :** **Job Description :** Your Job: • The purpose of the Provider Services Representative is multifaceted; it requires excellent interpersonal and communication skills, knowledge of managed care/health plans, and an understanding of the health care industry in order to effectively educate, communicate, share information, and facilitate relationships between providers contracted with Dallas Methodist Physicians Network (DMPN) and Methodist Patient Centered ACO (MPCACO) and their office personnel. The role intercedes in the resolution of claims payment issues and other administrative and procedural contractual requirements. The role works with physicians to channel patients to preferred and contractually affiliated entities for services and care as administrative prerogatives of health plans and ACO relationships. Your Job Requirements: • Bachelor's degree required • Must demonstrate a high degree of independence and a self-starter. • Must demonstrate the ability to respond to the expressed needs and concerns of physicians and office staffs, as well as initiate actions and proactively anticipate next steps. • Must demonstrate well-developed communication skills, both oral and written, to enable strong interpersonal interactions with physicians and office staffs. • Must demonstrate understanding of medical claims billing and coding practices. • Ability to follow a project from initiation through completion within a specified timeline • Ability to maintain strict confidentiality. • Working knowledge of hierarchical conditional categories (HCC). • Working knowledge of Microsoft products: Outlook, Word, Excel, and PowerPoint. • Work Experience: 5 years experience in managed care is required. Marketing experience is a plus. Your Job Responsibilities : • Orients and assists newly credentialed DMPN physicians within the first few months: Provides education to physicians and office personnel on the DMPN Physician Agreement, health plan contracts, fee schedules, claims processes, and regulatory requirements. • Serves as liaison between MHS physicians/office staffs and DMPN: (a) Obtains feedback from physician offices on health plans and health system issues; (b) Identifies needs and opportunities for improvement; (c) Provides quick response and follow-up with physicians concerns, problems and questions; (d) Attends weekly staff meetings, and gather information to be used for communications to physicians and office staff during visits; (e) Routinely meets with the DMPN President, to discuss physician issues and concerns. • Establishes, cultivates and maintains positive relationships between DMPN, the MPCACO, MHS and physicians/office staffs through: (a) Visiting and communicating with practices routinely to re-enforce communication among physicians and with health plans and the ACO, (b) Documenting contacts with physicians and staff through weekly summaries and monthly written reports, (c) Facilitating collaborative relationships with health plan representatives through physician office staff luncheons,(d) Writing a monthly physician newsletter (e) Conducting lunch and learn meetings with physicians and their office staff and health plan representatives to share information, (f) Working with physicians on the development of medical neighborhood and assisting in communication flow, (g) Facilitating communication between system hospitals and post-acute care providers and other health plan and ACO stakeholders, (h) Educating physicians on HCCs and quality metrics, and (i) Attending physician events and meetings to help maintain visibility with physicians. • Coordinates and facilitates an annual calendar of health plans and DMPN educational meetings. • Coordinates joint operating committee meetings with health plan representatives. • Assists DMPN President in the implementation and operationalization of health plan contracts. • Visits with all physicians at least annually. • Develops and maintains health plan contacts and contract grids/databases/spreadsheets. • Maintains DMPN's Blackboard sites with current information. • Communicates with MHS Physician Services Representatives on a regular schedule. • Assists President as needed to support goals including business development, growth, quality and physician satisfaction. • Projects a positive image of MHS to internal colleagues, external customers and the community. • Performs a variety of special projects and other related duties. Methodist Health System is a faith-based organization with a mission to improve and save lives through compassionate, quality healthcare. For nearly a century, Dallas-based Methodist Health System has been a trusted choice for health and wellness. Named one of the fastest-growing health systems in America by _Modern Healthcare_ , Methodist has a network of 12 hospitals (through ownership and affiliation) with nationally recognized medical services, such as a Level I Trauma Center, multi-organ transplantation, Level III Neonatal Intensive Care, neurosurgery, robotic surgical programs, oncology, gastroenterology, and orthopedics, among others. Methodist has more than two dozen clinics located throughout the region, renowned teaching programs, innovative research, and a strong commitment to the community. Our reputation as an award-winning employer shows in the distinctions we’ve earned: + Magnet® designations for Methodist Dallas, Methodist Charlton, Methodist Mansfield, and Methodist Richardson Medical Centers + 150 Top Places to Work in Healthcare by _Becker’s Hospital Review_ , 2023 + Top 10 Military Friendly® Employer, Gold Designation, 2023 + Top 10 Military Spouse Friendly® Employer, 2023 Methodist Health System is a faith-based organization with a mission to improve and save lives through compassionate, quality healthcare. For nearly a century, Dallas-based Methodist Health System has been a trusted choice for health and wellness. Named one of the fastest-growing health systems in America by _Modern Healthcare_ , Methodist has a network of 12 hospitals (through ownership and affiliation) with nationally recognized medical services, such as a Level I Trauma Center, multi-organ transplantation, Level III Neonatal Intensive Care, neurosurgery, robotic surgical programs, oncology, gastroenterology, and orthopedics, among others. Methodist has more than two dozen clinics located throughout the region, renowned teaching programs, innovative research, and a strong commitment to the community. Our reputation as an award-winning employer shows in the distinctions we’ve earned: + Magnet® designations for Methodist Dallas, Methodist Charlton, Methodist Mansfield, and Methodist Richardson Medical Centers + 150 Top Places to Work in Healthcare by _Becker’s Hospital Review_ , 2023 + Top 10 Military Friendly® Employer, Gold Designation, 2023 + Top 10 Military Spouse Friendly® Employer, 2023 Equal Opportunity Employer It is the policy of Methodist Health System (MHS) to select, develop, and promote employees based on individual ability and job performance. It has been, and will continue to be, the policy of MHS to provide equal employment opportunity to all people in all aspects of employer-employee relations without discrimination because of race, color, religion, national origin, age, sex, sexual orientation, gender expression, disability, marital status, genetic information or ancestry. This policy affects decisions including, but not limited to, an employee’s compensation, benefits, terms and conditions of employment, opportunities for promotion, training, development, transfer all other privileges of employment. MHS is committed to maintain a working environment free of intimidation, workplace discrimination and harassment. Retaliation or attempted retaliatory behavior that occurs as a result of an employee’s exercise of their rights under this policy or any other statutorily protected right is strictly prohibited and will be grounds for disciplinary action.