Provider Relations Specialist

Job Title

The primary functions are to coordinate and interface between the physician network, the IPA, and contracted HMOs by building relationships with the PCP network, strategizing efforts, and supporting and implementing the overall marketing plan set for the IPA. This position also provides administrative support to the IPA Manager.

Principal Duties and Responsibilities

• Administrative support for IPA Manager.
• Assist providers with issues related to contracting, capitation, claims, referrals, and eligibility, and act as liaison between provider and applicable department.
• Outreach to members as needed
• Provider correspondence including newsletters, fax blasts and mass mailings.
• Facilitate contracting, including drafting agreements, preparing Letters of Agreement and processing all agreements as directed by IPA Manager.
• Maintain all provider contract files and correspondence.
• Maintain PCP, Specialty and Ancillary rosters including health plan ID numbers
• Timely review and response to any health plan roster proof requests
• Complete audit tools for Health Plan audits upon request
• Process provider adds, changes, and terminations using checklists, including configuration notification and health plan notification, along with electronic file maintenance of the contract.
• Schedule and coordinate Health Plan JOCs
• Maintain provider manuals for PCP and Specialists including in-service materials for network provider field visits.
• Establish Cozeva and Aerial Care logins for providers and maintain records of logins provided
• Handle wrong lab claims for IPA, including cap deduct warning letters and tracking
• Act as liaison between providers and credentialing department.
• Assist with annual member and provider surveys
• Prepare IPA-related reports as needed
• Track, assist, educate and outreach to providers on initiatives such as encounter data submission, AV program and Clinical Initiatives.
• Conduct field visits to provider offices, visiting assigned PCPs and/or specialists at a minimum of once each month.
• Ongoing physician recruitment by promoting the IPA's complete compensation packages and services for Primary Care Physicians (PCPs) and select Specialists as approved by the client.
• Promote and market the IPA in San Diego County.
• Assist providers with patient service calls, patient retention, and patient growth with the goal of increasing overall senior membership to the PCP and IPA through FFS conversions into HMO and new senior patients (organic growth).
• Coordinate with Director of Business Development to organize and participate in marketing events as needed
• Research and maintain a working knowledge of current competitors in the IPA's respective community, including compensation, bonuses, and other offerings, to assist in highlighting the value differences and advantages of the IPA.
• Thoroughly and efficiently respond to all emails and/or voicemails that require any action in a timely manner.
• Maintain strict confidentiality regarding client, PDT proprietary information, and PHI according to HIPAA requirements.
• Attend all meetings and trainings as determined by the manager, whether in person or virtually
• To complete other tasks as assigned

Qualifications

• Two years of managed care experience or combination of education and experience
• Ability to read, interpret, and summarize documents such as medical contracts, operating and procedure manuals, comprehensive correspondence and memos.
• Ability to write routine reports, correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions from groups of managers, customers and other employees of the organization. Fluency in additional languages may be mandatory based on region.
• Excellent computer skills required specifically Word, Excel, Microsoft Outlook and PowerPoint.
• Maintain a valid driver's license, car insurance and reliable vehicle.
• Any type of remote/hybrid position may require approval by PDT Leadership and IPA Board of Directors with the criteria of time/distance to Office/IPA Hub.

Position Performance Criteria

1. Consistently produces accurate and timely work product as it relates to departmental goals.
2. Demonstrates high reliability through consistent punctuality and attendance.
3. Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow through.
4. Uses sound judgment with regard to time management and prioritization of work to balance multiple tasks and meet required timeframes for all administrative activities as required.
5. Demonstrates excellent interpersonal skills as discerned through observation and team project successes.
6. Accurately interprets and applies departmental policies and procedures using sound judgment.
7. Communicates clearly, professionally and respectfully to peers, superiors, subordinates and clients.
8. Demonstrates overall professionalism in attitude, demeanor and personal appearance
9. This position is primarily remote. There are also days in the field as well as occasional requirements at the Vista Office