Offer summary

Qualifications:

Bachelor's degree required., At least 5 years of customer service experience, including 2 years in network management., Strong relationship development and issue resolution skills., Experience with provider education and contract coordination..

Key responsibilities:

Manage relationships with contracted providers through regular visits and communication.

Resolve complex provider issues and facilitate provider education.

Coordinate provider contracts and participate in joint operation meetings.

Assist with provider training, policy communication, and claims resolution.

Job description

Job Description Summary

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This position is responsible for the performance of assigned contracted PCPs and PODs.

This is a remote position however candidates must be located in or around the San Bernadino/Inland Empire/Riverside/Pomona area.

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How will you make an impact & Requirements

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Senior Network Provider Relations

This is a remote position however candidates must be located in or around the San Bernadino/Inland Empire/Riverside/Pomona area.

Own individual performance engagement and on-the-ground relationship development for new and existing MDs. Key accountabilities include issue resolution, provider education and quality and performance.

Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
Serving as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution.
May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
Functions as a high level technical resource to resolve or facilitate complex provider issues.
Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.
Provide assistance regarding education, contract questions and non-routine claim issues.
Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
Tracks and conduct provider refresher training.
Researches issues that may impact future provider negotiations or jeopardize network retention.

Requirements:

Requires a Bachelor's degree
Minimum of 5 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
Travels to worksite and other locations as necessary.

Compensation: $77,832K - $97,290K & bonus eligible

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Required profile