Provider Relations Representative jobs in Hayward, CA

PRINCIPAL RESPONSIBILITIES:

Under general guidance from the Provider Services Manager, the Provider Relations Representative III is responsible for building long-term relationships with physicians, physician groups, ancillary and behavioral health providers and their staff in a positive and proactive manner in order to support their understanding and compliance with Alliance contracts, policies, and procedures.

Principal responsibilities include:

• Providing timely training per Alliance and state requirements and orientations for providers and their office staffs for new providers, upon request from an office, or as needed to introduce new programs, provide ongoing education, or new policies and procedures.
• Fostering and maintaining proactive positive relations throughout the provider network by communicating with provider offices through virtual and/or face-to-face visits, letters, telephone calls, faxes or emails for the purposes of promoting the Alliance, sharing data and information about the physician's practice, Alliance processes and other miscellaneous updates as well as for gathering information and feedback from the provider about any issues or concerns related to the Alliance or healthcare in general.
• Effectively identifying, directing, and/or researching provider operational issues for timely resolution per Alliance and state requirements through a thorough knowledge of all areas of Alliance operations and a strong working relationship with other departments.
• Assessing the composition of the existing network, the opportunities for expansion in assigned territories and the availability of services in the surrounding communities to provide a comprehensive overview and understanding of the medical community to both internal and external customers.
• Recruiting both new providers for participation in the Alliance network and existing providers for new lines of business and/or projects.
• Arranging for and conducting office manager group seminars and physician seminars and meetings including such tasks as coordinating meeting dates and times, scheduling a meeting space, locating speakers and preparing invitations, agendas, presentations, and handouts.
• Reporting from databases and other resources to provide information about the network to internal and external customers.
• Contributing to the development of written communications for the provider bulletin, manual, website and other publications and ad hoc reports and letters.
• Working with teammates to complete in-house projects, mailings and special projects as assigned.
• Providing primary coverage for Provider Services main phone line, general mailbox and other administrative tasks as needed.
• Participating in internal and external workgroups and meetings.
• Performing other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Identifying and researching a variety of issues related to provider contracting, compliance and operational issues utilizing various sources including, but not limited to, current contracts, publications, websites, etc. Reporting information in an appropriate manner either via reports, letters or verbal communication.
• Preparing and delivering verbal presentations in a group or one-on-one setting to Alliance network providers and their staff.
• Scheduling and performing provider outreach visits, trainings and orientation sessions to comply with Alliance and State requirements.
• Frequent driving of automobiles between the worksite and provider offices.
• Performing writing, administration, analysis, and report preparation.
• Problem identification and resolution.
• Excellent verbal and written communication skills.
• Leading and participating in internal and external committees and meetings.
• Complying with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Frequent use of telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and objects weighing between 0 and 30 lbs.
• Frequent walking and standing.
• Frequent driving of automobiles.

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Bachelor's Degree in any field or equivalent experience.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Three years job experience in provider relations for a managed care health plan or related healthcare environment preferred.
• Two years of experience with government-funded managed care programs, county services and IPA/medical group administration.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Excellent written and verbal communication and presentation skills and exercise sound judgment.
• Strong interpersonal, organizational, analytical and problem-solving skills.
• Healthcare experience working with a Medi-CalHMO plan highly desirable.
• Knowledge of provider relations responsibilities in a managed care setting.
• Customer service oriented and resourceful.
• Ability to work with others while completing multiple tasks simultaneously and successfully.
• Ability to make decisions in the absence of detailed instructions and work independently or in a team environment.
• Proficient in the use of Microsoft Office products (Word, Excel, Outlook, PowerPoint, and Access).
• Experience in HealthSuite and Webex or other virtual meeting platform preferred.
• Valid California driver's license, auto registration, and proof of insurance required.

SALARY RANGE: $60,524 - $90,786 ANNUALLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.