PROVIDER RELATIONS REPRESENTATIVE
Job
Summary:
Works closely with the provider community to identify and resolve issues, provide education and staff training, and ensure that providers are in compliance with the regulatory agencies set forth in River City Medical Group's (RCMG) contractual agreements.
Maintains accuracy of bulletins and communications with provider offices.
Interface with HMO liaisons on provider issues.
Assists with provider network contracting activities.
Essential Job Functions:
Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position.
Assist in development of physician visit policies and procedures to include visits, new providers orientation, implementation of new policies, and providing assistance to new physicians' and office staff as needed.
Document and file visitation records, and report on a regular basis to the Provider Relations Supervisor.
Assists with the development and implementation of provider training programs.
Provide education and staff training to provider offices of all applicable IPA and HMO guidelines.
In conjunction with the UM department, works 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 setup and contract configuration to ensure accurate claims processing.
Perform financial analysis 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 onboarding materials, monthly updates, and bulletins to keep provider offices informed of all changes.
Analyzes changing business; makes recommendations to management for process improvements as required.
Informs the Provider Relations Supervisor of operational problems and request resolutions in a judicious manner.
Proactively identify provider needs and advise management so that action can be taken to address the needs before they are problematic for the provider.
Coordinates, attends, and participate in various meeting as assigned.
May be required to report on major points, actions resolved or to be taken.
Recruitment of providers in consultation with Provider Relations Supervisor.
Assist in provider contracting.
This may include identification of new provider, standard contracting of primary care physicians, delivery of provider contract and all pertinent information for credentialing requirements.
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 Three years' experience in the medical industry.
Prefer previous provider relations experience in an IPA, health plan, or health care 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 50% of the time in the greater Sacramento area.
Work Environment This job operates in a professional office environment.
This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.
Recommended Skills Active Listening Attention To Detail Auditing Business Process Improvement Claim Processing Communication Estimated Salary: $20 to $28 per hour based on qualifications.
Summary:
Works closely with the provider community to identify and resolve issues, provide education and staff training, and ensure that providers are in compliance with the regulatory agencies set forth in River City Medical Group's (RCMG) contractual agreements.
Maintains accuracy of bulletins and communications with provider offices.
Interface with HMO liaisons on provider issues.
Assists with provider network contracting activities.
Essential Job Functions:
Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position.
Assist in development of physician visit policies and procedures to include visits, new providers orientation, implementation of new policies, and providing assistance to new physicians' and office staff as needed.
Document and file visitation records, and report on a regular basis to the Provider Relations Supervisor.
Assists with the development and implementation of provider training programs.
Provide education and staff training to provider offices of all applicable IPA and HMO guidelines.
In conjunction with the UM department, works 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 setup and contract configuration to ensure accurate claims processing.
Perform financial analysis 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 onboarding materials, monthly updates, and bulletins to keep provider offices informed of all changes.
Analyzes changing business; makes recommendations to management for process improvements as required.
Informs the Provider Relations Supervisor of operational problems and request resolutions in a judicious manner.
Proactively identify provider needs and advise management so that action can be taken to address the needs before they are problematic for the provider.
Coordinates, attends, and participate in various meeting as assigned.
May be required to report on major points, actions resolved or to be taken.
Recruitment of providers in consultation with Provider Relations Supervisor.
Assist in provider contracting.
This may include identification of new provider, standard contracting of primary care physicians, delivery of provider contract and all pertinent information for credentialing requirements.
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 Three years' experience in the medical industry.
Prefer previous provider relations experience in an IPA, health plan, or health care 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 50% of the time in the greater Sacramento area.
Work Environment This job operates in a professional office environment.
This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.
Recommended Skills Active Listening Attention To Detail Auditing Business Process Improvement Claim Processing Communication Estimated Salary: $20 to $28 per hour based on qualifications.
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