Specialist - Provider Relations (Remote) - Maximus

Maximus is currently looking for Provider Relations Specialists to join our FED NSA (No Surprise Act) team. The Provider Relations Specialist is responsible for working closely with the Provider Development and Retention Team, Provider Relations Team, and Report Tracking Specialists.

They are responsible for assisting in follow-up of providers who have incomplete evaluations and delinquent reports, maintaining provider relations by developing a working rapport with existing Providers, and facilitating the termination of providers who fail to exhibit an acceptable level of proficiency in both evaluations and reports.

Essential Duties and Responsibilities:

- Act as primary point of contact for IPP/IRP providers as assigned to provide technical assistance, and act as a conduit for all operational questions and issues.

- Collaborate with Operational Support Unit (OSU) to address clinical operational issues and/or concerns as needed.

- Responsible for making scheduled visits remotely/in person as assigned to provide training and education on Maximus policy and procedures as necessary, ensuring provider/consumer satisfaction and operational readiness/success.

- Engage IPP/IRP providers as required to assist monitoring turnaround time to ensure Service level Agreement (SLA) adherence.

- Assist with provider outreach between Medical Director and Clinical Manager to Clinicians as needed.

- Assist the Operations Support Unit and Credentialing teams with maintaining accurate Provider Data Files and availability.

- Assist with the recruitment of Clinicians in collaboration with Human Resources and Vendors as applicable.

- Collaborate with Human Resources and Vendor(s) to develop and implement effective recruitment strategies ensuring robust pipeline of candidates across platforms as needed.

- Ensure recruitment is aligned with geographic/program needs.

- Maintain Provider Profile Data Base (MaxEB).

The provider and plan liaison will serve as a critical link between healthcare providers, insurance plans, and the IDRE, established under the NSA. This role involves facilitating compliance with regulatory requirements and supporting the resolution of payment disputes between providers and insurers.

-Act as the primary point of contact for the NSA arbitrations email inbox team to handle inquiries submitted by healthcare providers and insurance plans participating in the IDR process

-Ensure timely and effective communication between the IDR entity, providers, and plans

-Address inquiries and concerns from stakeholders promptly and professionally

-Oversee all corrective actions related to inquiries and ensure that appropriate action is taken in a timely manner

-Monitor the progress of corrective actions to ensure compliance and resolution

-Ensure all actions and communications comply with the NSA and relevant regulations

-Guide providers and plans through the IDR process, offering clear explanations of requirements, timelines and procedures

-Maintain accurate and detailed records of all interactions, submissions and decisions

-Collaborate with internal teams to identify opportunities for improving the efficiency and effectiveness of the IDR process

-Provide feedback and recommendations based on stakeholder interactions and experiences

Education

- Bachelor's degree preferred; commensurate work experience may be substituted in lieu thereof

Experience

- Minimum of 2 years' experience in healthcare administration, insurance, dispute resolution or a related field

- Experience with the No Surprises Act or similar legislation required

Skills

- Strong understanding of healthcare billing, insurance practices, and regulatory compliance

- Excellent communication and interpersonal skills

- Ability to manage multiple tasks and stakeholders effectively

- Proficiency in data analysis and reporting

- Strong problem-solving and conflict-resolution abilities

- Detail-oriented with strong organizational skills

Home Office Requirements :

- Home office, free from noise and outside distraction with adequate power source.

- Reliable high-speed internet service.

- Minimum 20 Mbps download speeds/50 Mbps for shared internet connectivity.

- Minimum 5 Mbps upload speeds.

- Hardwired internet (ethernet) connection (No WiFi or Hotspot)

Minimum Requirements

- Bachelor's degree in related field, or equivalent combination of education and experience .

- 3-5 years of relevant professional eperience required.

- Knowledge of online recruiting tools and sourcing applications.

- Knowledge of Credentialing.

- High degree of technical knowledge and proficiency in navigating between multiple systems.

- Strong interpersonal and communication skills.

- Exceptional organizational skills and attention to detail.

- Ability to multi-task and prioritize job duties.

- Experience with CRM's is preferred.

- Excellent attention to detail exhibited through written, oral and documentation job responsibilities ability to thrive in remote work environment.

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.