Apply on Employer Site

Partnership HealthPlan of California · 3 months ago

Provider Relations Representative I

US-CA-Santa Rosa

Full-time

Onsite

New Grad, Entry Level

$72K/yr - $90K/yr

Partnership HealthPlan of California is seeking a Provider Relations Representative I to establish and maintain excellent relationships with the provider network. The role involves resolving complex issues, providing education and training, and ensuring effective communication between providers and the organization.

Health CareInsuranceNon Profit

Culture & Values

Responsibilities

Maintains regular schedule of provider office visits to ensure open lines of communication, answers questions, distributes information, and documents and follows-up on questions or concerns. Ensures each visit includes a well-documented Rep Visit Sheet

Investigates and responds to provider concerns. Serves as neutral liaison between providers and PHC departments in responding to questions and resolving issues. Assists with research and disposition of provider appeals and grievances

Trains provider offices via onsite visits and by telephone regarding PHC policies, procedures, and available resources

Creates educational materials and formal presentations

Conducts provider orientations and ongoing educational training sessions. Assists with meeting coordination to ensure agendas are distributed timely and materials and other required arrangements are prepared

Educates providers on the use of PHC provider information forms. Follows up with providers on incomplete forms to obtain required information

Resolve complex authorization or claims issues. Identify potential system issues, collaborate with affected departments to ensure resolution

Conducts monthly, quarterly, annual and ad hoc provider surveys

Creates Corrective Action Plans (CAPS) for provider sites that did not meet standards. Monitors compliance with CAP

Uses databases and tracking systems to document and retrieve information and run reports

Composes correspondence, conducts research, and prepares reports

Coordinates, attends, and participates in various meetings both on and off-site as assigned

May be required to report on major points, resolved and pending action items

Required to work with minimal supervision

Other duties as assigned

Qualification

Healthcare administrationProvider relationsPresentation skillsMicrosoft OfficeDatabase proficiencyMulti-tasking skillsJudgmentOrganizational skillsCommunication skillsDecision-making

Required

Bachelor's degree in health care administration, business, or public relations preferred, or equivalent combination of education and experience

prior experience with physician offices or managed care or health insurance environment preferred

Excellent oral and written communication and presentation skills

Excellent organizational, prioritizing, and multi-tasking skills required

Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy

Proficient in Microsoft Office (Word, PowerPoint, Excel)

Ability to use a variety of databases for research and entry of information

Valid California driver's license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business

Must be able to work in a fast-paced environment and maintain courtesy and composure

Ability to function effectively with frequent interruptions

Ability to lift, carry or move objects of varying size, weighing up to 25 lbs

Company

Partnership HealthPlan of California

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

Founded in 1994