Lead Provider Relations Representative

Description

Under the supervision of the Senior Manager Provider Relations, this position is responsible for physician recruitment related activities and building relationships with Providence contracted physicians/specialist offices. Key responsibilities include Physician office in-services, continuous physician office education, fielding questions, researching and resolving inquiries, identifying issues, management and dissemination of network communications, identifying and vetting new PCP contract opportunities, and overall network performance. This position works with leadership to develop action plan for specific metrics/providers needing improvement, identifies PCP & SPC network gaps, and manages network performance meeting agenda and follow-ups. Activities of this role can impact the open enrollment period, and submission of documentation and recuperation of coding to improve Risk Adjusted Factors (RAF) scores.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

The job duties listed are essential functions of the position. However, other duties may be assigned, and may also be considered essential functions of the position.

• Serves as an internal team resource for technical knowledge.

• Accountability for team on-boarding for new caregivers and training of staff.

• Creates documents and workflows for the team, such as Frequently Asked Questions and reference guides.

• Fosters a close working relationship with assigned physician offices including communicating with provider office regarding member/provider issues.

• Manages monthly provider visits and calendar of in-services to new and established physician offices. Assigned larger affiliate offices and manages performance with the physicians. Ownership for performance discussions.

• Interprets health plan policies and procedures and develops training tools and guidelines to train provider network to ensure compliance.

• Independently researches and resolves concerns/issues for provider offices and provides accurate and timely answers. Monitors and tracks service issues and inquiries for identification and trending of education opportunities/programs to improve overall provider service and satisfaction.

• Responsible for timely and accurate documentation in the CRM.

• Responsible for identifying providers within all specialties for recruitment. Completes executive summary for prospective physicians and follows appropriate hand-off process to ensure appropriate contract execution.

• Responsible for meeting Quality, HCC, growth and patient experience performance metrics.

• Meets annually established physician recruitment goals.

• Develops and deploys strategic network planning tools to drive provider engagement and performance across the enterprise.

• Conducts physician office meetings and other network trainings by planning, creating, and delivering presentations.

• Coordinates network-wide meetings and larger training workgroups.

• Prepares presentation materials.

• Manages SharePoint.

• Maintains trackers. Facilitate meetings with other departments that our department works with and accountability for the trackers for follow-up items. Ensures Reps conduct the follow-ups.

• May delegate assignment to Senior Provider Relations Reps.

• Project focused. Assists management with ad hoc projects.

• Collaboration with staff between regions to ensure alignment in processes.

• Coordinates and attends health fairs, senior events including ABC's of Medicare Meetings, employer events and other various enrollment functions to promote networks.

• Acts as a liaison with various Providence Departments, physician offices and health plans to resolve provider issues and facilitate notifications.

• Responsible for network performance. Oversees network performance meeting agenda and follow-ups.

• Facilitation between other internal departments; quality HCC, contracting, credentialing, etc.

• Works with leadership to develop action plan for specific metrics/providers needing improvement.

• Identifies PCP and SPC network gaps.

• Disseminates network communications.

• Serves as second-level review for new PCP contracts.

Job Specific Knowledge, Skills and Abilities:

• Advanced knowledge of managed care principles and methodologies.

• Experience with Cozeva preferred.

• Basic computer skills including Windows, Microsoft Office Word, Outlook, and Excel.

• Travel between Providence locations, as well as within assigned territory. Approx 50-60% travel required.

• Knowledge of medical terminology, medical billing, and medical office procedures.

• Strong interpersonal, organizational and leadership skills to achieve desired goals and to interact effectively with management and non-management staff and physician groups.

• Attention to detail and follow-up skills required.

• Must be able to maintain a positive attitude under changing conditions.

• Ability to seek out available resources to resolve problems.

• Must be able to make independent decisions.

• Must have a professional and mature demeanor.

• Must be able to work in a fast-paced department while handling multiple tasks, working with interruptions, and dealing effectively with confidential information.

• Advanced skills in MS Excel, Word, and PowerPoint.

Required Qualifications:

• Upon request: Driving may be necessary as part of this role. Caregivers are required to comply with all state laws and requirements for driving. Caregivers will be expected to provide proof of driver license and auto insurance upon request. See policy for additional information.

• 5 years experience in a Provider Relations role working with physicians in Affiliate/IPA, with a minimum 2 of these years at a Senior level Provider Relations role.

• 5 years Managed care Provider Relations experience.

Preferred Qualifications:

• Bachelor’s Degree in Healthcare Management or related field.

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.

Requisition ID: 330578
Company: Providence Jobs
Job Category: Provider Network
Job Function: Health Plans Services
Job Schedule: Full time
Job Shift: Day
Career Track: Business Professional
Department: 7520 PROVIDER RELATIONS CA HERITAGE SERVICES
Address: CA Torrance 4180 W 190th St
Work Location: Providence Administrative Offices-West 190th Street
Workplace Type: On-site
Pay Range: $32.40 - $51.29