McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.

We are looking for a Provider Relations Representative I to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/

Position Summary:

Responsible for the education and servicing of assigned provider groups regarding all aspects of the Plan and its subsidiaries. Responsible for assisting in the development of policy, procedures and educational materials for use with all Provider Programs and for the development of benchmarks to measure performance against the Plan’s goals. Establishes and maintains effective relationships with key physicians and office staff of contracted medical delivery entities (i.e. provider offices, specialists, etc.). Responsible for contracting of PCP’s, Specialists, and Ancillary providers in their defined servicing area. Responsible for claims research and resolution. All duties are to be carried out in collaboration with the contracting staff and other key senior staff as appropriate.

This position is fully remote. The position may require travel to various locations in the State of Indiana to provider offices.

#LI-AK1

• High School Diploma/GED.
• Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care claims operations or provider billing functions.
• Valid state driver’s license, reliable transportation, and automobile insurance coverage.

• Equivalent combination of two (2) years’ college coursework and experience in Managed Care claims operations or provider billing functions.
• Valid state driver’s license, reliable transportation, and automobile insurance coverage.

• Associate Degree in business, health care or related field.
• Two (2) years’ experience in contracting and/or servicing hospitals and/or physician organizations and their office staff.
• Established relationships with providers in the Plan’s service areas.

Additional Information

• Schedule: Full-time
• Requisition ID: 24003323
• Daily Work Times: 8:00 am - 5:00 pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.