Provider Relations Specialist

Physicians Datatrust - Lynwood, CA

Full-time

Provider Relations Specialist – Cerritos Office:

Our established Medical Management Company is built on more than 100 years of collective experience in the managed care (healthcare) industry. We specialize in managing independent groups of physicians with both commercial and senior managed care (HMO) patients.

We are looking for a super star candidate as our full-time, Provider Relations Specialist , responsible for being the liaison between the physician network, the IPA, and contracted HMOs by building relationships with the PCP network, strategizing efforts, and supporting and implementing the overall marketing plan set for the IPA.

Principal Duties and Responsibilities (* = essential functions):

· Administrative support for IPA Manager.

· Assist providers with issues related to contracting, capitation, claims, referrals and eligibility and act as liaison between provider and applicable department. *

· Outreach to members as needed

· Provider correspondence including newsletters, fax blasts and mass mailings. *

· Facilitate contracting, including drafting agreements, preparing Letters of Agreement and processing all agreements as directed by Director of Operations or IPA Manager.

· Maintain all provider contract files and correspondence. *

· Maintain PCP, Specialty and Ancillary rosters including health plan ID numbers *

· Timely review and response to any health plan roster proof requests

· Complete audit tools for Health Plan audits upon request

· Process provider adds, changes and terminations using checklists to include configuration notification and health plan notification along with electronic file maintenance of contract. *

· Schedule and coordinate Health Plan JOCs

· Maintain provider manuals for PCP and Specialists including in-service materials for network provider field visits.

· Establish MDX and Aerial Care logins for providers and maintain records of logins provided

· Handle wrong lab claims for IPA including cap deduct warning letters and tracking

· Act as liaison between providers and credentialing department.

· Assist with annual member and provider surveys

· Prepare IPA related reports as needed

· Track, assist, educate and outreach to providers on initiatives such as encounter data submission, AV program and Clinical Initiatives.*

· Conduct field visits to provider offices visiting assigned PCPs and/or specialists at a minimum of once each month.*

· On-going physician recruitment by promoting the IPAs complete compensation packages and services for Primary Care Physicians (PCPs) and select Specialists as approved by the client.

· Promote and market the IPA in the respective community.

· Assist providers with patient service calls, patient retention and patient growth with the goal of increasing overall senior membership to the PCP and IPA through FFS conversions into HMO and new senior patients (organic growth).

· Coordinate with Marketing Manager to organize and participate in marketing events as needed

· Research and maintain a working knowledge of current competitors in the IPAs respective community that includes compensation, bonuses and other offerings in order to assist in highlighting the value differences and advantages of the IPA.

· Thoroughly and efficiently, respond to all emails and/or voicemails that require any action in a timely manner.

· Maintain strict confidentiality regarding client, PDT proprietary information, and PHI according to HIPAA requirements.

· Attendance at Cerritos office or alternate location designated by the manager once a week and active participation in weekly meetings/trainings.

· To complete other tasks as assigned.

Qualifications:

· Two years of managed care experience or combination of education and experience

· Ability to read, interpret, and summarize documents such as medical contracts, operating and procedure manuals, comprehensive correspondence and memos.

· Bi-lingual Spanish speaking preferred.

· Ability to write routine reports, correspondence, and procedure manuals.

· Ability to effectively present information and respond to questions from groups of managers, customers and other employees of the organization. Fluency in additional languages may be mandatory based on region.

· Excellent computer skills required specifically Word, Excel, Microsoft Outlook and PowerPoint.

· Maintain a valid driver’s license, car insurance and reliable vehicle.

· Ability to travel between West Covina, Long Beach, Cerritos and Irvine

Our leadership operates within the highest level of integrity and respect, empowering staff with a strong support system. We are offering a solid opportunity with a growing company including full benefits, paid holidays and a competitive compensation within a progressive, friendly work environment.

If you consider yourself a qualified, stellar candidate driven to demonstrate your initiative and reliability, please submit your resume with "Provider Relations Specialist CVPG” as the subject line.

Thank you for your interest in joining our team; we look forward to hearing from you!

Job Type: Full-time

Experience:

  • relevant: 1 year (Preferred)
  • Customer Service: 1 year (Preferred)

Work Location:

  • One location

Benefits:

  • Health insurance
  • Dental insurance
  • Vision insurance
  • Retirement plan
  • Paid time off