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Healthcare Relations Specialist I

2 months ago

Fairfield, California, United States Partnership HealthPlan of California Full time

Overview:

The primary goal of this role is to cultivate and sustain strong connections with the provider network within a designated geographic area, which includes healthcare professionals, administrative staff, and management. This position collaborates closely to identify and address intricate issues, offers educational support, and conducts training sessions. Services and educational outreach are provided through both in-person visits and telephone communications. The role also assists providers in comprehending the policies and procedures of Partnership HealthPlan of California while aiding in the resolution of arising issues.

Key Responsibilities:

  • Regularly schedules visits to provider offices to maintain open communication, address inquiries, disseminate information, and document follow-ups on concerns. Each visit is accompanied by a thoroughly completed Rep Visit Sheet.
  • Investigates and addresses provider concerns, acting as a neutral intermediary between providers and PHC departments to respond to inquiries and resolve issues. Aids in the research and resolution of provider appeals and grievances.
  • Conducts training for provider offices through onsite visits and telephone consultations regarding PHC policies, procedures, and available resources.
  • Develops educational materials and formal presentations.
  • Facilitates provider orientations and ongoing training sessions, ensuring timely distribution of agendas and preparation of necessary materials.
  • Educates providers on the completion of PHC provider information forms, following up on incomplete submissions to gather required information.
  • Addresses complex authorization or claims issues, identifying potential system challenges and collaborating with relevant departments for resolution.
  • Conducts provider surveys on a monthly, quarterly, annual, and ad hoc basis.
  • Creates Corrective Action Plans (CAPs) for provider sites that do not meet established standards, monitoring compliance with these plans.
  • Utilizes databases and tracking systems for documentation, information retrieval, and report generation.
  • Composes correspondence, conducts research, and prepares detailed reports.
  • Coordinates, attends, and engages in various meetings, both on-site and off-site, as assigned.
  • May be required to report on significant points, resolved issues, and pending action items.
  • Works independently with minimal supervision.
  • Performs other duties as assigned.

Qualifications:

Education and Experience:
Bachelor's degree in healthcare administration, business, or public relations is preferred, or an equivalent combination of education and experience. Previous experience in physician offices or within a managed care or health insurance environment is advantageous.

Special Skills, Licenses, and Certifications:
Exceptional oral and written communication and presentation skills are essential. Strong organizational, prioritization, and multitasking abilities are required. Must demonstrate sound judgment in decision-making within the scope of authority and handle sensitive matters with discretion. Proficiency in Microsoft Office (Word, PowerPoint, Excel) is necessary. Ability to utilize various databases for research and information entry is required. A valid California driver's license and proof of current automobile insurance compliant with PHC policy are mandatory for operating a vehicle and traveling for company business.

Performance-Based Competencies:
Must thrive in a fast-paced environment while maintaining professionalism and composure. Ability to function effectively amidst frequent interruptions is essential.

Work Environment and Physical Demands:
At least 50% of work time is spent driving, with over 30% dedicated to working in front of a computer monitor. The ability to lift, carry, or move objects of varying sizes, weighing up to 25 lbs, is required.

Expectations for All HealthPlan Employees:

  • Deliver the highest possible level of service to clients;
  • Encourage teamwork and collaborative efforts among employees;
  • Maintain safe practices; and
  • Adhere to HealthPlan policies and procedures, which may be updated periodically.

HIRING RANGE:
$72,000 - $90,456.15

IMPORTANT DISCLAIMER NOTICE:
The job duties, elements, responsibilities, skills, functions, experience, educational factors, and requirements listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.