Provider Relations Representative - San Diego, CA

Caring. Connecting. Growing Together.

Primary liaison between the client and MSO for the delivery of Managed Care Administrative Services. Responsible for concise and complete explanations of all phases of services from each MSO Department to the assigned IPA groups and resolving issues between them.

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. Monitors' clients need to evaluate satisfaction levels and identifies trends and areas requiring improvement
• Manages the interface between providers, the MSO, and the health plans. Remains accessible to providers and their office staff. 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. Schedules regular visits to physician offices to provide education, training, and customer service. Establishes and maintains solid, productive relationships with office staff by providing superior customer service and effectively solving issues. Stays current with activities in the market by developing an open rapport with the offices. Represents management at all meetings with clients in an appropriate and professional manner
• 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
• Internet portal user set-up, training, documentation, communication and troubleshooting with vendors, as necessary
• Completes other duties as requested and assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.