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Healthcare Provider Relations Specialist

1 month ago

Redding, California, United States Partnership HealthPlan of California Full time
Job Summary

We are seeking a skilled Healthcare Provider Relations Specialist to join our team at Partnership HealthPlan of California. In this role, you will be responsible for establishing and maintaining excellent relationships with our provider network, including healthcare practitioners, office staff, and administrators.

Key Responsibilities
  • Maintain regular schedules of provider office visits to ensure open lines of communication, answer questions, distribute information, and document and follow-up on questions or concerns.
  • Investigate and respond to provider concerns, serving as a neutral liaison between providers and PHC departments in responding to questions and resolving issues.
  • Train provider offices via onsite visits and by telephone regarding PHC policies, procedures, and available resources.
  • Create educational materials and formal presentations to support provider education and training.
  • Conduct provider orientations and ongoing educational training sessions, assisting with meeting coordination to ensure agendas are distributed timely and materials and other required arrangements are prepared.
  • Educate providers on the use of PHC provider information forms, following up with providers on incomplete forms to obtain required information.
  • Resolve complex authorization or claims issues, identifying potential system issues and collaborating with affected departments to ensure resolution.
  • Conduct monthly, quarterly, annual, and ad hoc provider surveys to assess provider satisfaction and identify areas for improvement.
  • Create Corrective Action Plans (CAPs) for provider sites that did not meet standards, monitoring compliance with CAP.
  • Use databases and tracking systems to document and retrieve information and run reports, composing correspondence, conducting research, and preparing reports as needed.
  • Coordinate, attend, and participate in various meetings both on and off-site as assigned, reporting on major points, resolved and pending action items as required.
Qualifications
  • Bachelor's degree in healthcare administration, business, or public relations preferred, or equivalent combination of education and experience.
  • Prior experience with physician offices or managed care or health insurance environment preferred.
  • Excellent oral and written communication and presentation skills, with the ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.
  • Proficient in Microsoft Office (Word, PowerPoint, Excel) and ability to use a variety of databases for research and entry of information.
  • Valid California driver's license and proof of current automobile insurance compliant with PHC policy required to operate a vehicle and travel for company business.
Work Environment and Physical Demands

At least 50% of work time is spent driving, and more than 30% of work time is spent in front of a computer monitor. Ability to lift, carry, or move objects of varying size, weighing up to 25 lbs.

All HealthPlan employees are expected to provide the highest possible level of service to clients, promote teamwork and cooperative effort among employees, maintain safe practices, and abide by the HealthPlan's policies and procedures, as they may from time to time be updated.