Provider Relations Rep IV / Job Req 738502279

PRINCIPLE RESPONSIBILITIES:

Under general guidance from the Sr. Manager, Provider Services, the Provider Relations Representative IV is responsible for building long-term relationships with delegated partners (delegates), hospitals, large provider groups and/or medical groups and systems (including physicians, ancillary, behavioral health providers) and their leadership staff in a positive and proactive manner in order to support their understanding and compliance with the Alliances contracts, policies, and procedures.

Principle responsibilities include:

• Providing timely training per Alliance and state requirements and orientations for providers and their office staffs for new providers, upon request, or as needed to introduce new programs or new policies and procedures.
• Fostering and maintaining proactive positive relations throughout the provider network by communicating with providers through virtual meetings, 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.
• The liaison and primary contact for delegates, hospitals, providers and/or provider groups, physicians, ancillary and behavioral health providers.
• 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 the Alliance operations and a strong working relationship with other departments.
• Organizes and facilitates meetings and between Alliance leadership and providers for training and resolving identified issues.
• Organizes and conducts Joint Operation Meetings (JOM)
• Maintain timely and accurate meeting minutes.
• Tracks, follows up, and accurately documents action items resulting from JOMs.
• Collaborates with other Alliance departments on new initiatives and implementations to meet Alliance strategic goals with a focus on CalAIM initiatives.
• Track and communicate important updates, changes and reminders to providers and delegates.
• Supports delegates and providers in new transitions and ongoing support as needed.
• 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 provider group seminars and physician seminars and meetings including such tasks as 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.
• Assist in the creation and maintenance of department training materials.
• Perform administrative tasks as needed.
• Ability to train, coach, and act as a resource to staff.
• Participating in internal and external workgroups and meetings.
• Complete 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.
• Overseeing of major Provider Relations projects, including organization, planning, delegation of tasks and communication with provider.
• Preparing and delivering verbal presentations in a group or one-on-one setting to Alliance network providers and their staff.
• Acting as the primary trainer for new members of the Provider Relations team.
• 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:

• Five years job experience in provider services for a Medi-Calmanaged care health plan or related healthcare environment preferred.
• Two years' experience with government-funded managed care programs, county services and IPA/medical group administration.
• Two years' experience in physician/practice management operations desired.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Excellent written and verbal communication and presentation skills and exercise sound judgment.
• Strong interpersonal, organizational, analytical and critical problem-solving skills.
• Develop and maintain strong internal and external working relationships.
• Knowledge of Medi-Cal managed care.
• Knowledge of provider services responsibilities in a managed care setting.
• Customer service oriented and resourceful.
• Ability to manage multiple projects and tasks in a high pressure environment.
• Ability to make decisions in the absence of detailed instructions and work independently or in a team environment.
• Ability to work with others while completing multiple tasks simultaneously and successfully.
• Knowledge of healthcare practice management systems, electronic medical records, and/or billing systems highly desirable.
• Knowledge of CPT, ICD-10 and HCPCS coding highly desirable.
• Knowledge of physical payment methodologies highly desirable.
• Proficient in the use of Microsoft Office products (Word, Excel, Outlook, PowerPoint, and Access).
• Experience in HealthSuite preferred.
• Valid California driver's license, auto registration, and proof of insurance required

Employees who interact with members of the public may be required to be tested for Tuberculosis and fully vaccinated against COVID-19 and influenza. Successful candidates for those positions/ classifications may be required to submit proof of vaccination against influenza and/or COVID-19, a negative Tuberculosis test, or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates should not present proof of vaccination until instructed to do so by the Human Resources department.

SALARY RANGE $80,040.08-$120,060.11 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.