Provider Relations Specialist

Description

Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than 1,500 senior living community partners across 34 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the healthcare system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

**Position is remote, but must be located in Southern California as there is some travel to provider offices**

SUMMARY

The Provider Relations Rep works primarily as a liaison between network providers and the health plan including provider orientation, training, and nurturing positive relationships. The Provider Relations Rep will also coordinate with external and internal staff members to assist in the contracting process, credentialing/re-credentialing process, claim issue resolution, and other duties as assigned.  

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Responsible for conducting provider outreach by providing training and guidance to enable network providers to become self-sufficient in confirming eligibility, claim submission, prior authorization requirements.
• Communicates effectively to both internal and external stakeholders
• Coordinates with contractors to recruit preferred providers and assist in any gap closures, as applicable.
• Works with internal partners to streamline single case agreement process and report out on status as appropriate.
• Addresses, researches and escalates claims, billing and appeal issues for assigned providers in a timely manner. 
• Maintains outreaches and documentation within a tracking system.
• Understands department and organizational strategy and operating objectives.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

KNOWLEDGE, SKILLS AND ABILITIES

• Understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Excellent written and verbal communication skills
• Ability to manage multiple priorities in a fast-paced environment
• Committed to continuous process improvement
• Proficiency in MS Office applications (Word, Excel)
• Ability and willingness to travel up to 30% of the time

EDUCATION

• Bachelor’s Degree

EXPERIENCE

• 4 – 8 years of experience in provider relations and servicing managed care contracts with physician, hospital and/or other provider contracts.
• Experience in understanding value based concepts
• Experience contracting for Medicare Advantage; familiarity with Medicare Special Needs Plans (I-SNP, C-SNP) a plus.
• History of working with complex providers; providers may include, but are not limited to large institutional providers, large medical groups and ancillary providers.

The salary range is $80,000-$90,000.  Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, Curana Health offers benefits such as, a comprehensive benefits package, 401K, flexible PTO, paid holidays (all benefits are subject to eligibility requirements).

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.

Qualifications