Provider Services Representative
NAMM North America Medical Management - Rancho Cucamonga, CA

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Directly responsible for all provider services functions in the local market place representing the organization and functioning as a key member of the local field office. Working directly with the local Executive Directors to add maximum value to the IPA physicians.

  • Directly responsible for working with IPA physicians to ensure provider satisfaction in accordance with the IPA standards
  • Directly responsible for working with the designated health plan representatives on local issues and concerns (including directory accuracy)
  • Directly responsible for all physician education including distribution of key IPA documentation and policies and procedures and orientations
  • Directly responsible for education of physician’s management staff and performs regularly scheduled Office Manager’s meetings
  • Responsible for ensuring network compliance with regulatory requirements including but not limited to accessibility and availability of required specialties.
  • Responsible for understanding local market dynamics performing routine market analysis and organizing appropriate marketing and promotional activities
  • Responsible for ensuring network is maximized based on market analysis and that there are no network gaps, including identification of new providers.
  • Responsible for optimizing electronic connectivity between the providers and NAMM operations to ensure economical transaction management
  • Manage provider contracts deemed appropriate by the Executive Directo

  • Computer literate in word and excel. Access and power point experience preferred.
  • Excellent written and verbal language skills
  • Ability to work independently, organizing and prioritizing work flow
  • Ability to effectively present information and respond to questions from physicians, clients, customers and the general public.
  • Strong organizational and communication skills. Adept at problem solving.
  • Working knowledge of ICD-9, CPT and HCPCS coding.
  • Proficient at managing multiple tasks and priorities.
  • Able to construct and interpret contract language/terms.