Provider Relations Coordinator

7 days ago

Orange, California, United States Astiva Health, Inc Full time
Job Title: Provider Relations Coordinator

Astiva Health, Inc. is a premier healthcare provider specializing in Medicare and HMO services. We are seeking a highly skilled Provider Relations Coordinator to join our team.

About Us:

Astiva Health, Inc. is committed to delivering comprehensive care tailored to the needs of our diverse community. We prioritize accessibility, affordability, and quality in all aspects of our services.

Job Summary:

The Provider Relations Coordinator will perform 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.

Key Responsibilities:

  • Develop and maintain trusted relationships with providers to ensure they are engaged in company initiatives and compliant with state and federal regulations.
  • Collaborate with internal departments to improve provider performance in areas of Quality Risk Adjustment and Operations.
  • Interact effectively with PCPs, Specialists, and other contracted vendors/services through office visits, virtual visits, telephone calls, emails, and prompt resolution of issues.
  • Work with internal departments to assist providers with inquiries about claims, authorizations, benefits, and other issues.
  • Assist with the development of Dental and Acupuncture Direct Network.
  • Coordinate with the Sales/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.

Requirements:

  • 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, HIPAA 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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