Provider Relations Representative, Sr. jobs in Sacramento, CA

Job Summary:

Collaborates closely with the provider community to identify and resolve issues, provide education, and staff training, and to ensure compliance with our providers. Maintains accuracy of provider manuals, bulletins, and communications with provider offices. Interface with the HMO liaisons on provider issues. Assist with provider network contracting activities. Additionally serves as a resource to junior provider relations representatives.   Provides training and on boarding to new members of the department.  Cooperates with management in enforcing processes and coaching the junior members of the team.

Essential Job Functions:

Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position.

• Develop physician visit policies and procedures to include visits, new providers orientation, implementation of new policies and providing assistance to physicians’ office staffs, as needed. Document and file visitation records and report on a regular basis to Administrator & Executive Vice President. 
• Lead the development and implementation of provider training programs. 
• Lead staff development meetings for Provider Relations department. 
• Take an acting leadership role when the provider relations supervisor is away.
• Provide education and staff training to provider offices of all applicable IPA and HMO guidelines. 
• In conjunction with the UM Department, work closely with the provider community to identify and resolve issues and ensure compliance with rules, regulations and audits. 
• Effectively integrate new programs and strategies per member per month targets, and provide oversight to the provider set up and contract configuration to ensure accurate claims processing. 
• Perform financial analysis and reports to identify medical cost improvement opportunities, develop strategies to reach financial goals, and execute contracting strategies to meet goals and objectives. 
• Evaluate and monitor providers’ performance standards and financial performance of contracts. 
• Produce, maintain and ensure accuracy of IPA provider manuals. This includes provider monthly updates and bulletins to keep provider offices informed of all changes. 
• Understand and analyze changing business requirements; makes recommendations to management for process improvements as required. 
• Informs both administrative and clinical leadership of operational problems and requested resolutions in a timely manner. 
• Coordinates, attends and participates in various meetings as assigned. May be required to report on major points, actions resolved or to be taken. 
• Recruitment of providers as requested by provider network development. 
• Assist in provider contracting. This may include identification of new providers, standard contracting of primary care physicians, delivery of provider contract and all pertinent information for credentialing requirements. 
• Responsible for maintaining updated provider visit and communication log. 
• Maintains a well-documented desk procedure manual to include the job tasks, reports, processes and procedures required to ensure the consistent and timely completion of the duties of this position in the absence of the incumbent. 
• Training and orientation of new provider relation’s representatives.
• First level resolution of escalated problems by others in the department.
• May lead and direct the work of others.
• Leading data reporting and analysis projects to monitor financial and service relations with providers.
• Implementing processes and changes needed to maintain regulatory compliance, contract compliance or to improve quality.
• Coaching and mentoring of junior members of the team.
• Helps management enforce policies, procedures, and best practices.
• Responsible for maintaining updated provider visits and communications. Reports to Provider Relations Supervisor. 
• Maintains a well-documented desk procedure to include the job tasks, reports, duties of this position in the absence of the incumbent
• Performs related duties consistent with the scope and intent of the position.
• Regular attendance.
• Travel as required.

Other Functions:

•  Enforces Company policies and safety procedures.
• Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.

Competencies

• Five years’ experience in the medical industry with at least three years being in provider relations in an IPA, health plan, or health care or medical office management setting.
• Must have reliable transportation.
• Excellent communication skills, including both oral and written.
• Excellent active listening and critical thinking skills.
• Ability to solve mid-level problems with minimal supervision.
• Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers.
• Ability to develop and present training materials to an audience.
• Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
• Ability to provide and receive constructive job and/or industry related feedback.
• Ability to maintain confidentiality and appropriately share information on a need to know basis.
• Ability to consistently deliver excellent customer service.
• Excellent attention to detail and ability to document information accurately.
• Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
• Demonstrate commitment to the organization’s mission.
• Must have mid-level skills in Microsoft software (Word, Excel, PowerPoint).
• Must have the ability to quickly learn and use new software tools.
• Must have mid-level skills using e-mail applications.
• Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
• Ability to work independently as well as in a team environment. 
• Ability to present self in a professional manner and represent the Company image.

Education and Licensure

• Associate degree in a related field
• BA or BS preferred.
• The education requirement may be waived based on years of experience.
• Current California Driver’s License is required

Travel

The incumbent may travel up to 80% of the time in their assigned Northern California rural county geographic area.  There will also be an expectation to travel into the headquarters office in Sacramento for training and when requested. 

Work Environment

This job operates in professional office environments. This role routinely uses office equipment such as computers, phones, photocopiers and scanners. Office equipment will be provided and supported as needed.