Provider Relations Coordinator

4 weeks ago

Orange, United States Astiva Health, Inc Full time

Job Title: Provider Relations Coordinator (Bilingual - Korean)

Target Compensation Range: $23.00 - $30.00/hour, depending on the relevant qualifications and experience.


About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.


SUMMARY: The Provider Relation Coordinator is responsible for providing the highest level of service to IPA’s, Medical Groups, MSO’s, providers, hospitals, and ancillary providers (Network Providers). The PRC is responsible for participating in the recommendation, development and implementation of Quality-of-Service strategies which improves operations and provider satisfaction.


ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

  • Establishes and maintains positive working relationships with contracted providers.
  • Responds timely to provider calls/voicemails and emails. Works with internal departments to resolve and close the issues related to contracting, capitation, claims, referrals, and eligibility.
  • Confirms provider information by phone calls to ensure correct provider directory as required.
  • Processes provider adds, changes and terminations requests from Medical Groups/IPA daily. Communicate and validate provider demographics to comply with the Health Plans SB137 regulations as needed.
  • Assists with provider portal account for contracted providers.
  • Provides virtual portal training to contracted providers.
  • Assists the Credentialing department by following up with providers to collect pertinent documents as needed.
  • Coordinates with the Sale/Marketing Department to organize and participate in marketing events as needed.
  • Schedules and coordinates meetings with providers for education purposes and initiatives such as annual wellness exam.
  • Other duties may be assigned as needed.


EDUCATION and/or EXPERIENCE:

  • High School diploma or GED required
  • Bachelor’s degree in Healthcare Administration, Finance, Business Administration or related field or a combination of education and experience
  • 2-3 years previous experience in a provider relations role within a health plan, IPA, or medical group strongly desired.
  • Strong working knowledge of Medicare, Medicaid and HMO health plan required.
  • Stellar critical thinking with the ability to independently research complex issues.
  • Bilingual in Korean (verbal and written)


BENEFITS:

  • 401(k)
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance
  • Paid Time Off

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