Provider Relations Specialist

4 weeks ago

Campbell, United States Insight Global Full time

Title: Network Management Associate (Provider Relations Specialist)

Duration: 4 Month Contract to Hire

Location: Campbell, CA

Schedule: Monday to Friday, 8am-5pm PST

Pay: $80K-$97K, based on experience



DUTIES INCLUDE BUT NOT LIMITED TO:

  1. Work with client to insure adequate physician network retention, expansion and recruitment.
  2. Responsible for provider education regarding services, policies, and procedures.
  3. Responsible for handling daily provider inquiries, including capitation and reimbursement issues.
  4. Assist in physician communication programs and strategy.
  5. Responsible for maintaining strong relationships with contracted Health Plans (HMO and PPO).
  6. Communicate with payors and network providers, both orally and written, in association with operational and contractual related issues.
  7. Serve as client liaison and advocate with all departments.
  8. Assist in client related projects.
  9. Assist in identifying issues, problems, and areas where performance could be improved.
  10. Represent at physicians’ offices, contracted health plans, and committees when necessary.
  11. May attend client meetings where necessary to facilitate communication of information.
  12. Develop and present educational pieces at network provider meetings.
  13. Assist in periodic statistical performance reporting to clients.
  14. Assist Network Management and Member Services Manager with the development of strategic plans for servicing network physicians.
  15. Develop, recommend, and implement new policies and procedures.
  16. Play a key supportive role in Quality Initiatives.
  17. Perform other job as assigned.


KNOWLEDGE, SKILLS AND ABILITIES

  • Knowledge of managed care market, strategies, and physician compensation models.
  • Knowledge of medical group/IPA operations.
  • Verbal and written communication skills.
  • Public speaking and interpersonal skills.
  • Ability to present oneself professionally and have the ability to address large groups of people in educational forums.
  • Research and analytical skills.
  • Ability to research complex contractual documents for interpretive purpose and utilize critical thinking skills.
  • Skilled in Word, Excel, Power Point, and Visio.
  • Ability to prioritize.
  • Ability to analyze complex situations and accurately identify key components.
  • Ability to multi-tasks simultaneously.
  • Ability to travel locally.
  • Knowledge of claims payment systems.
  • Excellent problem-solving skills and is able to identify and adapt to shifting priorities.


Must Have:

  • Bachelor’s degree in business, health care or related field, OR equivalent experience required
  • 3 years of experience with quality assurance, provider relations, network management, or similar in a healthcare setting.

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