Provider Relations Representative
Network Medical Management - Alhambra, CA
IPA NETWORK SPECIALIST OVERVIEW
The Provider Relations Representative is responsible for field and office activities in educating and supporting the IPA’s provider network as well as new provider recruitment and enrollment growth opportunities. Assisting in network development of primary care physicians and specialists providers. Must have understanding of Managed Care operations, able to communicate effectively, and organize in person meetings with individuals or group settings.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
  • Contract and development of network
  • Negotiate favorable capitated contracts with health plans on behalf of our client IPAs
  • Must be able to have effective interaction with all Providers.
  • Participate in all new business development.
  • Promote the integrity of the provider network.
  • Research and resolve authorizations, claims, eligibility concerns..
Provide support and ongoing education to contracted providers and their office staff regarding IPA policies, procedures, and contractual obligations to ensure compliance with state and federal regulations. Develop collaborative relationships with VIP Physicians, Health Plan Representatives and affiliated hospital physician relations staff. Participate and conduct provider network administration functions including but not limited to: status changes, member transfers, Health Plan and inter-departmental reporting to ensure cycle completion. Assess the adequacy of the IPA’s primary care and specialty care physicians in each geographic division to ensure proper coverage. Participate in departmental, hospital and health plan joint operations meetings. Attend weekly Provider Services/Marketing Meeting and Network Administration Meeting, Quarterly Hospital Joint Operation Committee Meetings and Quarterly Health Plan Joint Operation Committee Meetings. · Ability to handle member/provider concerns in an empathetic and caring manner

LANGUAGE SKILLS

  • Bilingual: English, Spanish (required).
  • The ability to write business correspondence and effectively communicate verbally with patients, providers, health plan representatives, and employees of the organization. Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conform to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors.
EDUCATION and/or EXPERIENCE
Associate’s degree (A.A.) from a two (2) year community college or equivalent and/or a combination of education and experience.
Minimum five (5) years related experience and/or training in a Managed Care organization in handling physician contracting, provider relations, community outreach, marketing, or network development; or equivalent combination of education and experience.

Monster - 9 months ago - save job - block