Provider Relations Representative at MEMORIAL HEALTH SERVICES in Fountain Valley, California

Posted in General Business 7 days ago.

Type: Full-Time





Job Description:

Essential Functions and Responsibilities of the Job


  • Always exemplify exceptional customer service to providers' offices, exhibiting professionalism at all times.
  • Open communication with leadership on open provider issues and facilitation of resolution.
  • Requires discipline and transparency as the position is largely field based
  • Be at work and be on time
  • Follow company policies, procedures and directives
  • Interact in a positive and constructive manner
  • Prioritize and multitask

Essential Job Outcomes

  • Responsible for establishing and maintaining relationships with providers and their office managers by planning scheduled office visits to a minimum of 18-24 MCMG and GNP offices (PCP and specialists) in designated territory weekly. Log all visits in Sales Force within 48 hours of visit.
  • Provides detailed on boarding to new physicians who join the network.
  • First line of contact for all interdepartmental requests related to provider relations issues.
  • Reports any dissatisfaction among providers, escalating concerns to management as appropriate, and resolves within limits of authority, reporting issue and resolution to the provider relations management team or supervisor.
  • Assist with activities and functions as they relate to physician growth as well as identifying network trends and gaps by working with internal departments and analyzing reports.
  • Assists with Power Point presentations, hand-outs, packets and agendas as assigned.
  • Primary coordinator/trainer of portal implementation and responsible for increasing portal enrollment.
  • Assist contracting with obtaining copies of contracts related to network management and ACO initiatives. Track findings in Sales Force or provided tracking in a timely manner and escalate issues to leadership.
  • Serve as in-house PR rep weekly, staffing provider relations line and assisting other departments in resolving provider issues.
  • Coordinates with customer service department to resolve provider issues.
  • First line of contact for all interdepartmental requests related to Provider Relations issues.
  • Reports any dissatisfaction among providers and resolves within limits of authority, reporting issue and resolution to the Provider Relations management team or supervisor.
  • Assist with activities and functions as they relate to physician growth as well as identifying network trends and gaps by working with internal departments and analyzing reports.
  • Assists with provider events, Power Point presentations, hand-outs, packets and agendas as assigned. Staff primary care physician form, mixers and other physician events.
  • "Other duties as assigned"
Experience

  • Minimum of two years' experience in a Provider Relations position required.
  • Epic or equivalent Managed Care electronic medical record system and provider portal applications knowledge preferred. Experience with various healthcare industry regulatory agencies and requirements, including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred.
  • Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is a must.

Education

  • Bachelor's degree required.