1 - 3 years of experience required
Responsible for supporting the administrative functions of the provider networks and serving as a resource for the network, department and clinician network liaisons.
- Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
- Resolves provider issues by interfacing with HCP central departments (Contracting, Eligibility, Claims and Finance).
- Reports systemic operational issues to the management team.
- Coordinates provider outreach for the CCR.
- Follows up with Payor Contracting department on status of clinicians being added, terminated as well as open / closed panel status based on health plan website and submitted information.
- Verifies annually the single / dual affiliation status of physicians and follows up when they are not maintaining this status.
- Serves as a point of contact to central departments for issues related to the network, communicates relevant information from the central departments to the network and provides communications and documents upon request.
- Makes outreach and follow up phone calls to physician offices related to specific initiatives or meetings (i.e. leadership retreat, RADV audit and AEP meetings).
- Researches pay for performance discrepancies.
- Completes Notice of Changes and Preferred Provider Lists ensuring information on these forms are inputted in IDX, HCP Connect, Visual Cactus and health plan websites.
- Attends and helps prepare adhoc meetings (i.e. office manger HCC training and lunch and learn).
- Takes minutes for specialty JOC meetings.
- Assists management in developing a quarterly IPA Bulletin containing articles and announcements for the IPA network.
- Prepares benefit flyers for primary care physicians with health plan ID numbers.
- Serves as administrative support for Clinician Network Liaisons on days they are not in the office.
- Collects bios and pictures for website.
- Responds timely to CSR’s.
- Delivers incentive and other checks.
- Responds to and resolves questions or concerns from clinicians or staff in a timely and service oriented manner.
- Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Performs additional duties as assigned.
- One or two years of post-high school education or a degree from a two-year college.
- Bachelor’s degree preferred.
- Over 1 year and up to and including 3 years of experience.
- Prior experience in a health plan, medical group or IPA setting working with physician networks.
- Customer service exp erience
Since 1992, HealthCare Partners has been committed to developing innovative models of healthcare delivery that improve our patients' quality...