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Provider Relations Specialist

2 months ago

Orange, California, United States Astiva Health, Inc Full time

Job Title: Provider Relations Coordinator (Bilingual - Korean, Vietnamese, or Chinese)

Target Compensation Range: $26.00/hour, depending on the relevant qualifications and experience.

About Us:

Astiva Health, Inc. is a leading healthcare organization dedicated to Medicare and HMO services. We focus on delivering inclusive care tailored to the diverse needs of our community, emphasizing accessibility, affordability, and quality in all our offerings. Our mission is to enhance healthcare delivery and positively impact the lives of our members.

SUMMARY: The Provider Relations Coordinator plays a vital role in ensuring exceptional service to Independent Practice Associations (IPAs), Medical Groups, Management Services Organizations (MSOs), and various healthcare providers. This position involves contributing to the development and execution of Quality-of-Service strategies aimed at enhancing operational efficiency and provider satisfaction.

ESSENTIAL DUTIES AND RESPONSIBILITIES include:

  • Fostering and maintaining constructive relationships with contracted healthcare providers.
  • Promptly addressing provider inquiries via calls, voicemails, and emails, collaborating with internal teams to resolve issues related to contracts, capitation, claims, referrals, and eligibility.
  • Verifying provider information through phone communications to ensure accurate provider directories.
  • Managing daily requests for provider additions, modifications, and terminations from Medical Groups/IPAs, ensuring compliance with Health Plans SB137 regulations.
  • Supporting contracted providers with their portal accounts.
  • Delivering virtual training sessions on the provider portal.
  • Assisting the Credentialing department by following up with providers to gather necessary documentation.
  • Collaborating with the Sales/Marketing Department to organize and participate in promotional events.
  • Coordinating educational meetings with providers regarding initiatives such as annual wellness exams.
  • Performing additional duties as assigned.

EDUCATION and/or EXPERIENCE:

  • High School diploma or GED required.
  • Bachelor's degree in Healthcare Administration, Finance, Business Administration, or a related field, or a combination of education and experience.
  • 2-3 years of experience in a provider relations capacity within a health plan, IPA, or medical group is strongly preferred.
  • Comprehensive knowledge of Medicare, Medicaid, and HMO health plans is essential.
  • Excellent critical thinking skills with the ability to independently investigate complex issues.
  • Bilingual proficiency in Korean, Vietnamese, or Chinese (both verbal and written).

BENEFITS:

  • 401(k)
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance
  • Paid Time Off