Provider Relations Coordinator

1 week ago

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

POSITION SUMMARY

This role reports directly to the Director of Provider Engagement. The individual will play a crucial role in assisting the Provider Engagement Department with the 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, the position entails supporting providers through the facilitation of quality improvement initiatives for IPA physicians.

KEY RESPONSIBILITIES

  • Organize and assist in the preparation of Regional Client meetings, which may encompass QA/UR Committee meetings, Credentialing Committee meetings, and Marketing events. These meetings may occur outside of regular hours and at off-site locations. Responsibilities may include taking minutes and tracking action items to ensure follow-up.
  • Provide assistance in generating ad hoc reports and completing various projects as assigned.
  • 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:
    • Making strategic planning recommendations to achieve IPA and Regional Network objectives.
    • Monitoring the utilization of healthcare services and the overall quality of care.
    • Managing financial transactions, including payments from agencies, health plans, and capitation and claims payments to physicians and other providers.
    • Facilitating provider office visits, HCC/STARs initiatives, and addressing other provider-related issues.
    • Overseeing Electronic Data Interchange and reporting data to clients and health plans.
    • Handling grievances, appeals, and reimbursement matters.
    • Addressing claims reimbursement issues and analyzing provider trends.
    • Initiating and executing 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 various business operations and projects effectively within time constraints.
  • Strong attention to detail and a commitment to taking ownership of assigned responsibilities.
  • Proficiency in Microsoft Office products and general computer literacy.
  • Ability to build and maintain relationships with internal staff and external partners, including health plans, hospitals, and healthcare providers.
  • Excellent communication, interpersonal, and time management skills, with the capability to conduct presentations, lead formal meetings, and write professional correspondence.
  • A valid driver's license and reliable transportation for on-site and off-site work are essential.
  • Preferred: Two years of experience in IPA or Provider Network administration or comparable managed healthcare experience.
  • Preferred: Familiarity with health plan managed care agreements and physician/provider agreements.
  • Preferred: Understanding of EMR systems and benefits management software.

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