Member and Provider Liaison - Denver Health Medical Plan

We are recruiting for a Member and Provider Liaison - Denver Health Medical Plan to join our team!

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Department

Managed Care Administration

****Remote Opportunity. Must Be a Colorado Resident.****

Job Summary

Under minimal supervision, this position will conduct outreach by telephone, email and in-person to improve members relations, provider relations and network building. This role will work with training and marketing departments to plan educational events for providers; and assist in the development of community events to increase awareness, advocacy, and strategic partnerships with community-based referral sources. This position will focus on provider engagement using DHMP proprietary platforms including the Provider Directory and Member/Provider Portal and build strategic relationships within network providers and their staff. This position will work alongside contracting, credentialing, claims and marketing teams to ensure all member and provider requests and communications are processed in a timely manner and that all activities/events are compliant with state, federal, and regulatory requirements. This role will also manage community relations and act as a local presence for DHMP members and partners. The Member and Provider Liaison is expected to maintain ethical conduct and will be responsible for the quality and satisfaction of prospective and current providers.

Essential Functions :

• Increase brand awareness of DHMP and other partners by educating providers, stakeholders, referral sources, civic leaders, community members and other audiences on DHMP program benefits, identifying differentiators from other healthcare options and isolating key value propositions in relation to audience group and specific needs. (5%)
• Provide program education through presentations, events, meetings, or other necessary communications with providers, members, potential members and other audiences as needed. (15%)
• Manage assigned strategic relationships, ensure continuous and effective communication with contacts, and respond to all inquiries, requests, and referrals timely. (10%)
• Identify appropriate events, community partners, or other resources and opportunities to educate members, potential members, the community at large, providers and their staff. (5%)
• Perform necessary administrative functions of the program to include, but are not limited to, developing informational trainings, and putting together handouts/packets with approved marketing materials. (5%)
• Under supervision, creates and maintains relationships with external and internal healthcare providers. Serve as a liaison and the primary point of escalation between assigned provider groups and DHMP.
  (20%)
• Manages and owns the DHMP Provider Payor request portal as well as provider admin attestations. Helps Provider Relations & Engagement Specialist in obtaining provider information for QNXT such as TIN, NPIs and other information as needed.
  (5%)
• Recruit new providers into the network as needed. (0%)
• Works with various team members to obtain necessary information to address contract, configuration, claims, Credentialing, Grievance & Appeals, and other provider related matters. (5%)
• Help with overall marketing communications annual strategy and other communications tasks as needed. (0%)
• Monitor metrics and benchmarks which assess the healthcare provider experience, engaging the appropriate departments within Managed Care to analyze various trends. (5%)
• Run provider reports as needed. (0%)
• Interacts with External Providers collaboratively in order to facilitate healthcare services for the Plan's members. (5%)
• Reviews and responds to member and provider voicemail and email messages within 48 hours. (5%)
• Manages workload in accordance with identified priorities and makes recommendations in modifying processes as needed. (5%)
• Attends various meetings as required. (5%)
• Assists with provider outreach to complete One Time Agreement Contracts as needed. (5%)
• Participate in all marketing communications, marketing strategy and campaign management as needed. (0%)

Education :

• High School Diploma or GED Required

Work Experience :

• One year of experience working in the health plans industry required.
• Prefer experience in Health Plan Services, Provider Relations, Member Relations, Healthcare Marketing & Engagement, or Claims.

Licenses :
Knowledge, Skills and Abilities :

• Must have strong interpersonal skills (written and verbal).
• Proficiency in Microsoft Word and Outlook required; Microsoft Excel preferred.
• Highly organized and flexible. Able to meet submission deadlines.
• Skilled public speaker, willing and comfortable to present in front of audiences.
• Comprehensive understanding of the health care delivery system, including economic structures and incentives that run counter to the patient's best interests, federal and state regulatory requirements with respect to health care eligibility, coverage, and services of various public programs a plus.
• Familiarity with healthcare organizations and general population dynamics within the specific service area.

****Remote Opportunity. Must Be a Colorado Resident.****

Shift

Work Type

Regular

Salary

$60, - $87, / yr

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to , and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF programÂ

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For more about our commitment to diversity visit: