Provider Relations Coordinator
1 week ago
POSITION SUMMARY
The Provider Engagement Coordinator reports directly to the Director of Provider Engagement. This role is essential in assisting the Provider Engagement Department with the operational management of IPA Regional Networks. Responsibilities include effective communication with client leadership and physicians, addressing physician concerns, and collaborating with AMM departments to meet client operational requirements. Additionally, this position supports providers by facilitating quality improvement initiatives for IPA physicians.
KEY RESPONSIBILITIES
- Organize and assist in the planning of Regional Client meetings, which may encompass QA/UR Committee sessions, Credentialing Committee gatherings, and Marketing events. These meetings may occur outside regular hours and at off-site locations. Responsibilities include taking minutes, maintaining action items, and ensuring follow-up.
- Provide assistance in generating ad hoc reports and managing various projects as needed.
- Ensure adherence to all relevant state and federal regulations, as well as health plan directives.
- Collaborate closely with the Administration Manager to guarantee that all Regional Network services are delivered with optimal quality outcomes. Key areas of focus include:
- Strategic planning that aligns with IPA and Regional Network objectives.
- Monitoring utilization of healthcare services and overall quality of care.
- Managing financial transactions, including funding and disbursements related to agencies, health plans, and capitation payments to physicians and other providers.
- Conducting provider office visits and addressing HCC/STARs initiatives and other provider-related matters.
- Overseeing Electronic Data Interchange and reporting data to clients and health plans.
- Handling grievances, appeals, and reimbursement issues.
- Addressing claims reimbursement challenges and provider trends.
- Initiating and executing all provider and ancillary agreements, along with health plan contract requirements.
- Coordinating marketing events throughout the year and nurturing relationships with broker partners.
EDUCATION & EXPERIENCE REQUIREMENTS
- Bachelor's or Master's degree in Health Care Administration or Public Health Administration from an accredited institution.
- Proven ability to manage diverse business operations and effectively oversee multiple projects within specified timeframes.
- Strong attention to detail and a commitment to taking ownership of assigned responsibilities.
- Proficiency in Microsoft Office Suite and general computer literacy.
- Ability to build and maintain relationships with internal staff and various business partners, including health plans, hospitals, and healthcare providers.
- Excellent communication, interpersonal, and time management skills, with the capability to present information, conduct formal meetings, and write professional correspondence.
- Possession of a valid driver's license and reliable transportation for on-site and off-site work is essential.
- A minimum of two years of experience in IPA or Provider Network administration or comparable managed healthcare experience is preferred.
- Familiarity with health plan managed care agreements and provider agreements is advantageous.
- Understanding of EMR systems and benefits management software is preferred.
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