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Provider Relations Coordinator

2 months ago

Long Beach, California, United States Advanced Medical Manage Full time
Job Overview

POSITION SUMMARY

The Provider Engagement Coordinator, reporting to the Director of Provider Engagement, plays a crucial role in supporting the operations of IPA Regional Networks. This position is essential for facilitating communication between client leadership and healthcare providers, addressing physician concerns, and collaborating with various departments to meet client operational requirements. Additionally, the role involves assisting in the enhancement of physician quality improvement initiatives.

KEY RESPONSIBILITIES

  • Organize and assist in the coordination of Regional Client meetings, which may encompass QA/UR Committee meetings, Credentialing Committee meetings, and Marketing events. These meetings may occur outside regular hours and at off-site locations. Responsibilities include taking minutes, tracking action items, and ensuring follow-up.
  • Support the generation of ad hoc reports and undertake additional projects as necessary.
  • 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. This includes:
    • Providing strategic planning insights to meet IPA and Regional Network objectives.
    • Monitoring healthcare service utilization and overall care quality.
    • Managing financial transactions, including agency payments, health plan funding, and claims payments to providers.
    • Facilitating provider office visits and addressing HCC/STARs initiatives.
    • Overseeing Electronic Data Interchange and reporting data to clients and health plans.
    • Handling grievances, appeals, and reimbursement challenges.
    • Addressing claims reimbursement issues and analyzing provider trends.
    • Initiating and managing all provider and ancillary agreements, including health plan contracts and responsibility matrices.
    • Coordinating marketing events throughout the year and maintaining 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 business operations and effectively handle multiple projects within set timeframes.
  • Strong attention to detail and accountability for assigned responsibilities.
  • Proficiency in Microsoft Office applications.
  • Ability to effectively engage and build relationships with internal teams and external 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 duties.
  • Minimum of two years of experience in IPA or Provider Network administration or related managed healthcare experience is preferred.
  • Familiarity with health plan managed care agreements and provider contracts is advantageous.
  • Understanding of EMR systems and benefits management software is preferred.