Provider Relations Coordinator

Description

About Us:
Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

Summary : Under the general supervision of the Provider Relations Manager & VP, the Provider Relations Coordinator performs a variety of routine and semi-routine tasks requiring a thorough knowledge of organizational policies and procedures. This position will provide administrative and operational support for the Provider Relations Department.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Routine visits to providers as assigned to develop a trusted relationship and maintain open lines of communication between Astiva Health and the providers, and to ensure they are engaged in the company’s initiatives, meet necessary deadlines, and remain compliant with state and federal regulations, and company policies and procedures.
• Collaborate with internal departments to improve provider performance in areas of Quality Risk Adjustment and Operations such as claims and encounters.
• Interact effectively with PCPs, Specialists and other contracted vendors/services through office visits, virtual visits, telephone calls, emails, prompt resolution of issues, and excellent customer service.
• Work with internal departments to assist providers with inquiries about claims, authorizations, benefits and other issues.
• Work closely with assigned IPAs to ensure they receive timely and accurate information regarding company’s initiatives, services, programs, policies and procedures, and quality measurements.
• Assists Manager in coordinating meeting with IPAs/Medical Groups quarterly or as needed.
• Assists with the development of Dental and Acupuncture Direct Network.
• Coordinate with the Sale/Marketing Department to organize and participate in marketing events as needed.
• Review, verify and lead investigation and resolution of reported Provider Directory inaccuracies.
• Participate in special projects and assignments as required.
• Other duties may be assigned.

Requirements

QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Must be able to travel between service counties.

EDUCATION and/or EXPERIENCE :

- Minimum of two (2) years of experience in Medical Group/IPA, Managed Care, and HMO.

- Minimum of one (1) year of experience in provider network development and/or provider network management capacity, account management, or provider relations experience in a managed care organization.

- In-depth knowledge of contracting, reimbursement, credentialing, and operations, and must be proficient with MS Office Suite and other database software.

- Knowledge of Medicare regulations, NCQA, HIPPA compliance

BENEFITS:

· 401(k)

· Dental Insurance

· Health Insurance

· Life Insurance

· Vision Insurance

· Paid Time Off

LANGUAGE: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups and customers or employees of the organization.

MATHEMATICS: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

EEO/AFFIRMATIVE ACTION STATEMENT: It is the policy of Astiva Health to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. This policy relates to all phases of employment, including but not limited to recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company sponsored employee activities. Provisions in applicable laws providing for bona fide occupational qualifications, business necessity or age limitations will be adhered to by the organization where appropriate. Please refer to Standard Operating Procedure 100 for more information about the organization’s Affirmative Action/EEO statement.

PHYSICAL DEMANDS : The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit and complete work while on a computer. The employee occasionally is required to stand, walk, use hands to finger, handle or feel, reach with hands and arms, stoop, kneel, crouch or crawl, climb or balance, talk and hear.

While performing the duties of this job, the employee is occasionally required to lift or exert force up to 10 pounds.

WORK ENVIRONMENT : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.