Provider Relations Representative
Partnership HealthPlan of California - Eureka, CA

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POSITION PURPOSE

To recruit and retain Physicians and ancillary Providers and maintain all related contracts, files and network information.

ESSENTIAL DUTIES AND RESPONSIBILITIES
  • Recruits new physician and ancillary providers, conducts office orientations. Trains office and provider staff on managed care concepts, policies and procedures.
  • Investigates and responds to providers concerns.
  • Maintains provider contract and correspondence files.
  • Composes correspondence, conducts research and prepares reports as needed.
  • Uses automated database and tracking systems to retrieve and update information and generate reports.
  • Serves as a neutral liaison between providers and PHC departments in resolving issues and problems.
  • Prepares statistical information related to contract activities.
  • Develops Provider Newsletter articles, bulletins and updates for the Provider Manual as requested.
  • Documents credentialing activities for Quality Management Coordinator.
  • Assists with disposition of provider grievances.

SECONDARY DUTIES AND RESPONSIBILITIES
  • Participates in special projects and assignments as required.

HIRING CRITERIA

Education and Experience

Bachelor's degree in Healthcare, Marketing, Public Relations or related field; minimum three (3) years healthcare, marketing or public relations experience in a managed care environment preferred; or equivalent combination of education and experience.

Special Skills, Licenses and Certifications

Working knowledge of business software applications. Knowledge of managed care concepts, policies and procedures. Must have access to own reliable vehicle with proof of insurance coverage in conformity with State law. Valid California driver's license.

Performance Based Competencies

Excellent oral and written communication skills. Excellent organizational skills with ability to prioritize assignments, maintain accurate records, files and documentation. Ability To use good judgment in making decisions within scope of Authority and to handle sensitive issues with tact and diplomacy.

Work Environment And Physical Demands

Ability to use microcomputer keyboard. More than 30% of work time is spent at a video display terminal. When required, ability to move, carry or lift objects weighing up to 35 lbs. Ability to operate a vehicle used for company business.

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.

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Partnership HealthPlan of California - 14 months ago - save job - copy to clipboard
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