Provider Relations Representative

Primary Responsibilities

• Coordinates and co-chairs all client board and regional meetings within assigned territory.
• Maintains official copies of minutes, agendas, and credential signatures at the MSO's office.
• Sends announcements regarding scheduled meetings, makes phone calls to verify attendance (quorum), orders refreshments and sets up/breaks down the meetings.
• Prepares, or directs the preparation of, agendas, handouts, and meeting minutes.
• Represents management at all meetings with clients in an appropriate and professional manner.
• Serves as a resource for internal referrals on provider issues.
• Supports the Client Services Department in resolving provider issues and responds to training needs identified by other MSO departments such as Claims and Medical Management.
• Interfaces with Health Plan staff as required.
• Effectively problem solves issues as identified; documents all contact with providers/office staff in the provider's file.
• Makes regular visits to physician offices to provide education, training, and customer service.
• Leaves specific instructions about how to be reached within and outside the office.
• Utilizes email and the cell phone to maintain productivity within and outside the office.
• Manages the interface between providers, the MSO, and the health plans.
• Recruits providers in designated geographic areas, negotiates provider contracts within specified guidelines and assists the Director of Network Management in all phases of network negotiations and contracting.
• Investigates interested providers for consideration by the regional committee.
• Notifies health plans and appropriate internal departments of provider contract and status changes.
• Functions as a messenger between plans and IPA clients, as applicable, during contracting functions.
• Develops provider manuals, provider directories, provider communications, and other related materials; and facilitates the distribution of such information.
• Completes other duties as requested and assigned.

Required Qualifications

• 2+ years of experience in managed care operations and/or a clinical/office setting.
• Experience training individuals on managed care policies and procedures in small or large groups. Presentation skills.
• Experience organizing meetings and taking minutes.
• Knowledge of CPT, ICD-9 Codes.
• Exposure to contract language, rates, and coverage definitions.
• Computer literacy, including competence with various word processing and managed care programs. Microsoft Office familiarity.
• Demonstrated ability to communicate in a professional manner, have critical thinking skills, and work independently.
• Demonstrated ability to work effectively with a wide variety of people at all levels.
• Demonstrated ability to conduct on-line meetings and conference calls.
• Proven excellent organizational and people skills.
• Reliable transportation, valid California Driver's License, and proof of insurance.