Address
Form of workProvider Relations Executive
Guaynabo, PR
ABOUT US
At Grupo Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results.
When you join Grupo Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.
Let's build healthier communities together, join now!
ABOUT THE ROLE
Requires ability to learn and follow policies, procedures and standards of their area, department and other related departments. Performs planning efforts within the department, whether for operational situations from day to day or project assignments or to coordinate multiple resources within the department or division. Anticipates customer needs and act proactively to ensure their satisfaction. Responsible to influence recommendations or decisions through critical reviews. Maintain a direct relationship with administrative personnel and Participants Providers through immediate and effective attention of needs presented by the Providers, GMPs or Alliances.
WHAT YOU'LL DO
Provides guidance to suppliers through visits where they distribute information on billing and claims documentation of claims adjustment, coverage, coordination of benefits, established policies and service delivery model, forms, referrals and others.
Guides the provider on their usage profile, presents and discuss reports, among others.
Identifies common and repetitive problems and implement corrective action and channel requests for information and\or claims from providers.
Support to the Credentialing Department, provides guidance to the Alliances, GMP/PCPs and Specialists about the credentialing and re-credentialing process.
Offers seminars to provider's office staff about the process of Claims, Billing, Electronic Health System, Triple-S platform, Coordination of Benefits and company policies, utilization, profiles, and incentives.
Promote and monitor compliance with the required rate of encounter by PCP's.
Orient the providers about the circular letters and the changes that occur in the Health Care Model.
Communicate the results of provider claims denials before they occur.
Evaluate the billing process of the providers and measure progress.
Identify and report findings in writing to the supervisor and provide a copy to the Provider Manager, PMG Financial Advisor Manager, Contract Manager and Vice President of the division through established processes.
Conduct informal surveys of satisfaction with our service provider.
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes.
WHAT YOU'LL BRING
Bachelor's Degree in Business Administration or Health Science or Natural Sciences, preferably; with one (1) to three (3) years of related experience.
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.
Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans". Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Females, Veterans and Disabled to Apply
