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Provider Relations Specialist

2 months ago

Hilo, Hawaii, United States AlohaCare Full time
Job Summary

AlohaCare is seeking a skilled Provider Relations Representative to join our team. As a key member of our organization, you will play a vital role in implementing strategic retention, recruitment, and educational activities to support our provider network goals.

Key Responsibilities
  • Communication
    • Support department participation in organizational efforts such as open enrollment, quality initiatives, NCQA accreditation, MQD readiness, HSAG audits, and other activities.
    • Produce reports, including fulfillment of state contractual requirements and organizational needs.
    • Contribute to the coordination, development, and execution of communication products such as surveys, directories, manuals, handbooks, websites, newsletters, and provider advisories.
    • Stay informed about current issues in the health industry and communities we serve.
    • Represent AlohaCare at external provider events, including exhibit booths, conferences, and meetings.
  • Retention of Providers
    • Schedule and meet with providers and/or staff in assigned territory.
    • Record daily contact of visits and interactions with providers in a shared database.
    • Support implementation of strategic provider network retention efforts.
    • Resolve provider issues, including internal process improvement, authorizations, complaints, benefits, contracts, fees, and other issues.
  • Recruitment of Providers
    • Coordinate activities for the proactive identification and pursuit of contracts with providers to participate in AlohaCare's network based on department priorities.
    • Identify and assist in the resolution of barriers to contracting with priority providers.
  • Education of Providers
    • Coordinate and conduct provider educational and training activities, including presentations in large and small groups, one-on-one, and online settings.
    • Assist in the development of educational and training materials and logistical arrangements for education and training events.
  • Other Responsibilities
    • Implement solutions to proactively address provider network issues on Oahu.
    • Facilitate inter-departmental collaboration for projects, process improvement, and ongoing operations.
    • Maintain AlohaCare's confidential information in accordance with AlohaCare policies, and state and federal laws, rules, and regulations regarding confidentiality.
    Requirements
    • High school diploma or equivalent
    • Minimum of three years customer service, one year healthcare, or comparable experience
    • Current valid Hawaii driver's license and access to an insured vehicle
    • Strong verbal and written communication skills, including public speaking and interpersonal interaction
    • High energy level and ability to perform repetitive tasks in a fast-paced work environment
    • Flexibility and adaptability to changing priorities
    • Intermediate skill using Microsoft Programs; Word, Excel, Outlook, and PowerPoint
    • Ability to think critically with strong multi-tasking skills
    Preferred Qualifications
    • Bachelor's degree
    • Provider and/or health plan experience
    • Medicaid and/or Medicare experience
    Working Conditions
    • Inside/Remote working conditions
    • Frequent travel (driving) within assigned territory
    • No environmental hazards
    • Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects
    • Occasional inter-island travel with occasional overnight stays
    • Verbal and written communication in English

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans' status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.