Provider Relations Coordinator

7 days 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: Under the general supervision of the Provider Relations Manager & VP, the Provider Relations Coordinator performs a variety of routine and semi-routine tasks requiring a thorough knowledge of organizational policies and procedures. This position will provide administrative and operational support for the Provider Relations Department.


ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

  • Routine visits to providers as assigned to develop a trusted relationship and maintain open lines of communication between Astiva Health and the providers, and to ensure they are engaged in the company’s initiatives, meet necessary deadlines, and remain compliant with state and federal regulations, and company policies and procedures.
  • Collaborate with internal departments to improve provider performance in areas of Quality Risk Adjustment and Operations such as claims and encounters.
  • Interact effectively with PCPs, Specialists and other contracted vendors/services through office visits, virtual visits, telephone calls, emails, prompt resolution of issues, and excellent customer service.
  • Work with internal departments to assist providers with inquiries about claims, authorizations, benefits and other issues.
  • Work closely with assigned IPAs to ensure they receive timely and accurate information regarding company’s initiatives, services, programs, policies and procedures, and quality measurements.
  • Assists Manager in coordinating meeting with IPAs/Medical Groups quarterly or as needed.
  • Assists with the development of Dental and Acupuncture Direct Network.
  • Coordinate with the Sale/Marketing Department to organize and participate in marketing events as needed.
  • Review, verify and lead investigation and resolution of reported Provider Directory inaccuracies.
  • Participate in special projects and assignments as required.
  • Regular and consistent attendance
  • Other duties may be assigned as needed.


EDUCATION and/or EXPERIENCE:

  • Minimum of two (2) years of experience in Medical Group/IPA, Managed Care, and HMO.
  • Minimum of one (1) year of experience in provider network development and/or provider network management capacity, account management, or provider relations experience in a managed care organization.
  • In-depth knowledge of contracting, reimbursement, credentialing, and operations, and must be proficient with MS Office Suite and other database software.
  • Knowledge of Medicare regulations, NCQA, HIPPA compliance
  • Bilingual in Korean (verbal and written)


BENEFITS:

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

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