Allegiance Benefit Plan Management, Inc. is a national leader in the administration of innovative and customized employee benefit plans for companies, associations and government agencies across the country. Our highly-trained and experienced team of claims professionals, nurses, doctors, attorneys, accountants, managers, and systems & benefits experts all take great pride in providing outstanding service that dramatically improves the experience, outcomes and cost of healthcare for employers and their members.  While Allegiance's goal is to provide clients with the highest level of service, we know that ultimately the products and services we administer serve the needs of individuals and their families. In all that we do, we realize that ours is a business focused on benefiting people and helping to improve their healthcare journey.

REPORTS TO:  Provider Relations Manager                                                       FLSA STATUS: Non Exempt

 POSITION RESPONSIBILITIES:

Through a respectful, constructive and energetic style guided by the objectives of the company, negotiates contract and works to establish and enhance effective working relationship between Allegiance and its Providers.

The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.

ESSENTIAL JOB FUNCTIONS:

Essential job functions include the following.  Other functions may be assigned as business conditions change.

• Network Development
• Participate in network strategy and development
• Assist in implementing defined strategy
• Perform analyses to identify providers to concentrate on and appropriate contract terms
• As directed, meet with providers to negotiate contract terms
• Participate as directed in alternate reimbursement methodologies

• Provider Relations
• Meet with providers on a defined periodic bases to develop relationships
• Review and respond to provider disputes
• Answer provider questions via email and phone calls
• Assist to improve the image and awareness of Allegiance in the Provider Community
• Manage providers' relations tools
• Attend annual and semi-annual events supporting providers

• Contract Management
• Prepare contracts for signature
• Perform analyses to determine appropriate contract terms
• Track contract and monitor receipts
• Follow up on all outstanding contracts

• Administration
• Claims repricing
• Create and maintain special fee schedules
• Provider analytics and reports
• Contribute to the daily workflow with regular and punctual attendance
• Supervision

• Oversee Provider Relations Coordinator and Provider Relations Assistant performance
• Generate & revise training materials, as needed
• Formulate training plan for each employee, as needed, and ensure it is executed in a timely manner
• Contribute to the workflow with regular and punctual attendance.

NON-ESSENTIAL JOB FUNCTIONS:

Performs related or other assigned duties as required or directed

SUPERVISION EXERCISED:

Not applicable

PHYSICAL WORKING CONDITIONS:

Physical requirements are representative of those that must be met to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sitting                           50%                                          Reaching                      Some

Standing                       25%                                          Manual Dexterity           Medium

Walking                        25%                                          Telephone                     Yes

Kneeling                       Some                                       Computer Screen          Medium

Bending                                    Some                                       Lifting                           up to 40 lbs.

Travel                           Significant

JOB SPECIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education:                            Bachelor's degree in business or related field preferred; bachelor's degree or an equivalent amount of knowledge and experience required. 

Certification(s) Required:                      None

Minimum Experience:                          Three years experience in the health care or health insurance industry preferred.

Other Qualifications:

• Excellent oral and written communication skills required.
• Strong negotiation skills required.
• Strong analytical and problem solving capabilities
• Strong PC skills, including Windows, Word, Excel and Adobe Acrobat.
• Must be able to adapt to software changes as they occur.
• Knowledge of medical terminology and health insurance concepts.
• Thorough understanding of claims processing procedures and requirements.
• Ability to think creatively to produce solutions to claims processing problems.
• High level of interpersonal skills to work effectively with others.
• Strong communications, listening, facilitation and consulting skills.
• Excellent project management skills.
• Demonstrated ability to be a change agent and foster innovative solutions.
• Ability to organize and recall large amounts of detailed information.
• Ability to project a professional image and positive attitude in any work environment.
• Ability to comply with privacy and confidentiality standards.
• Ability to be flexible, work under pressure and meet deadlines.           

The above statements are intended to describe the general nature and level of work being performed.  They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.