- Managed Care
- Network Administration
The Provider Relations - Field Representative is responsible for field and office activities in educating and supporting the IPA’s provider network. The Representative will be responsible to work closely with contracted providers and assist in contracting with new primary care and specialist providers.
An individual with at least three (3) years experience in health plan, IPA/PPG, clinic, and/or hospital setting is preferred. The individual must have an understanding of Managed Care operations (i.e., patient referrals, claims process, eligibility information, contracting, etc.)
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
- Must be able to have effective interaction with all Providers.
- Promote the integrity of the IPA.
- Provide support and ongoing education to contracted providers and their office staff regarding IPA policies, procedures, and contractual obligations to ensure compliance with state and federal regulations.
- Develop collaborative relationships with Physicians, clinic organizations, Health Plan Representatives and affiliated hospital staff.
- Must be able to research and understand authorizations, claims, eligibility, and compliance items raised by physician practices or health plan partners.
- Assist with outreach to contract with primary care and specialist providers.
- Participation in new business development projects.
- Help facilitate monthly or quarterly meeting with clinic, hospital, and/or health plan partners.
- Participate and conduct provider network administration functions including but not limited to: status changes, member transfers, Health Plan and inter-departmental reporting, distribution of reports to contracted providers, etc.
- Assess the adequacy of the IPA’s primary care and specialty care physicians in each geographic division to ensure proper coverage.
- Participate in departmental, hospital and health plan joint operations meetings.
- Attend monthly Provider Network and/or Operations Meeting, Quarterly Hospital Joint Operation Committee Meetings, and Quarterly Health Plan Joint Operation Committee Meetings.
- Ability to handle member/provider concerns in an empathetic and caring manner.
- Must be able to travel to Network Medical Management, Inc. offices in Alhambra, CA as needed.
Job Type: Full-time
- health plan, IPA/PPG: 3 years (Preferred)