PROVIDER NETWORK LIAISON

About the role

The Provider Network (PN) Liaison is responsible for promoting NEMS' network and MSO services to the medical community, providing ongoing education, and managing service relationships with providers and referral sources.

Responsibilities

• Develop and maintain relationships with community organizations, physicians, and healthcare administrators through in-person outreach activities.
• Plan and conduct in-service meetings to highlight NEMS network features and benefits and respond to complex provider inquiries.
• Represent NEMS MSO at networking and community events.
• Exercise discretion and independent judgment to address complex provider network issues, such as authorizations, claims, provider appeals, and benefit coverage.
• Conduct orientation, training, and education sessions for contracted provider entities and business associates.
• Interpret and communicate CMS/DHCS health policy changes to community providers and organizations.
• Aid in workflow training for new team members.
• Design and develop marketing materials.
• Manage provider outreach/visits logs and collaborate with internal and external parties for audit findings.

Requirements

• Bachelor’s degree or equivalent work experience in healthcare settings.
• 4 years of work experience in provider network, claims, or utilization management.
• Prior experience in a managed healthcare setting, preferably with knowledge of CMS and/or DHCS health policy.
• Superior communication skills, both spoken and written, with a variety of professionals, including physicians and other healthcare providers.
• Detail-oriented and organized with strong organizational and problem-solving skills.
• Ability to self-manage and work with multiple departments and external clients.

Qualifications

• Fluency in English and preference for fluency in Chinese (Cantonese and/or Mandarin).
• Strong PC literacy, including Excel, Word, PowerPoint, and Outlook skills.
• Knowledge of community resources and cultural background is a plus.
• Ability to work in a field-based role with 60% local travel in Northern California.