Job Description

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

The purpose of this position is to provide exceptional business service to our network of participating providers by serving as the primary liaison between providers and the health plan as well as identifying new providers to complement and expand the network. The Provider Business Consultant will execute on-boarding, education, and outreach activities to ensure provider adoption, adherence, and compliance with Parkland Community Health Plan (PCHP) quality management and accountable value-based care programs. The Provider Business Consultant will continuously execute PCHP’s network development plan to ensure best-in-class performance toward improving our quality of care, improving our patient experience, and reducing avoidable costs. 

 Minimum Specifications

Education

• High school diploma or equivalent
• Bachelor's Degree in healthcare related field preferred.

Experience

• 4 years of provider support, education, relationship management or contracting experience is required.
• 3 years of claims, billing, coding, or revenue cycle management experience is required.
• Three (3) years of direct healthcare fee schedule and/or charge master maintenance experience is preferred.
• Three (3) years of claims/billing systems maintenance and configuration is preferred.

Equivalent Education and/or Experience

• Additional education can substitute for experience requirements.

Skills or Special Abilities

• Advanced knowledge of health care including managed care programs that administer Medicare and/or Medicaid.
• Advanced level knowledge of provider reimbursement methodologies.
• Advanced level knowledge of network development strategies, clinical integration, and accountable value-based care principles.
• Expertise in gaining consensus and negotiating performance improvement plans.
• Effective knowledge of the Texas Department of Insurance, the Office of the Inspector General and other state agencies involving claims and Fraud, Waste and Abuse programs.
• Functional knowledge of Current Procedural Codes (CPT), ICD-10, CMS 1500 professional claims, UB ancillary, and hospital clean claim guidelines.
• Ability to utilize personal computer applications.
• Advanced level written and oral communication skills.

Responsibilities

1. Develops and maintains effective working relationships with assigned providers to include Hospitals, Physicians, Federally Qualified Health Centers, Rural Health Centers, Ancillary and other post-Acute providers.
2. Accountable for research and resolution of claims processing workflow and quality improvement process and provider reimbursement issues.
3. Conducts continuous education and outreach to ensure adoption, adherence, and compliance with PCHP policies, procedures, quality improvement and value-based care programs.
4. Performs provider on-boarding and orientation, including the development of related presentation materials.
5. Conducts organized meetings with assigned providers and develops all supportive materials including meeting minutes, action plans, memoranda, etc.
6. Executes provider recruitment to ensure network adequacy and resolves network access gaps.
7. Serves as subject matter expert around provider reimbursement.
8. Supports and collaborates with all PCHP functional areas.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.