Provider Relations Administrator

Who We Are

PACE by IIH is empowering senior participants to age at home with dignity through personalized, comprehensive care plans that deliver high-quality health and human services along with strong community support. Through an interdisciplinary and participant-centered model of care, PACE by IIH is committed to improving quality of life, promoting independence, and providing compassionate support tailored to the unique needs of each participant. Our team works collaboratively to deliver innovative, community-based healthcare solutions that allow seniors to remain safely and comfortably in their homes while receiving the care and services they need to thrive.

Benefits

• 401(k) 
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid sick time
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Job Summary
The Provider Relations Administrator is responsible for developing and maintaining relationships with Innovative Integrated Health’s (IIH) Provider community which includes provider groups, physicians, hospital systems, skilled nursing facilities, home health, durable medical equipment and other organizational providers and administrators. The Provider Relations Administrator is the conduit for existing and new providers regarding contracts, reimbursement rates, referrals and credentialing.  The Provider Relations Administrator is a community representative and will work on projects to enhance the provider network such that network adequacy in the specialties that are needed are developed.  

Essential Job Functions
Duties include, but are not limited to:

• Serves as liaison with the provider community. 
• Receives and responds to external provider related issues.
• Develop workflows, strategies, and special projects to meet provider network needs.
• Represents and promotes the knowledge of PACE to the Provider community in a professional and positive manner.
• Provider relations consist of several diverse provider contract administrative duties including direct provider engagement and training, regularly scheduled service visits with targeted providers, network capability monitoring, contract negotiations and resolution of provider issues.
• Responds to general provider contract inquiries.
• Responds to provider education needs and non-routine claim issues.  May research, analyze and recommend resolution for provider disputes.
• Conduct provider outreach by conducting training and guidance to enable network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of the provider portal.
• Attend and participate in staff meetings, in-services, projects, and committees assigned.   
• Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.
• Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
• Be flexible in schedule of hours worked.
• Travel to other Innovative Integrated Health may be necessary on occasion for coverage needs.
• May be required to use personal vehicle, if applicable. If using a personal vehicle, a valid California Driver’s License is required.