Provider Relations Representative

Job Summary:
The position of Provider Relations Representative is to oversee the compliance of our contracted providers as well as represent the organization out in the field. The main duties include but are not limited to providing orientations and continuous education to new and existing providers. Ensure compliance with all company policies and mandates. Maintaining positive relationships with assigned networks as well as working in conjunction with PR Coordinators to resolve issues and prevent issues from arising.

The following job functions are included, but not limited to:

• Act as liaison between Prospect Medical and contracted Providers to facilitate positive communication, excellence in service and provide assistance where needed
• Return phone calls within twenty-for (24) hours to ensure that professional and business relationships are maintained
• Schedule and conduct initial provider orientations within 30 days of contract effective date. Orientation includes all items as outlined in current new provider orientation manual.
• Coordinate with PR Coordinator to ensure that new provider is scheduled for orientation with our contracted laboratory within 48 hours credentialing approval date/contract effective date
• Conduct routine and follow up visits to all Premier, PCP, SCP providers as outlined in the department policy and procedures, as well as ensure they are up to date with the most current information available
• Conduct routine visits to all other providers as outlined in department policies to provide a forum for information exchange, allow monitoring and oversight of contractual responsibilities, ensure effective problem resolution, and facilitate communication between provider relations department and provider
• Educate providers about industry requirements and performance measures, i.e. HCC, P4P, etc.
• Assist providers in maintaining compliance with Encounter Data submissions
• Comply with production reporting requirements as stated in Department Policies and Procedures
• Become savvy in all aspects of Prospect Medical systems. This includes IDX, Cerecons, and other data bases as identified by management team.
• Use common sense and exercise good judgment in prioritizing workload
• Effectively communicate with Manager, escalating issues appropriately as needed
• Work well and develop relationships with Provider Relations Coordinators and other departments to effectively resolve issues that require root cause resolution from individuals within Prospect Medical
• Participate in large group presentations to providers or other constituents
• Notify Manager of trends and problematic areas within networks applying problem solving skills and offering solutions to issues
• Work with Provider Relations Manager and team members to prepare for the annual office manager and physician meetings
• Work on special projects as assigned by Management
• Perform other duties as assigned

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

• Proficiency in Microsoft Word and Excel
• Typing 40 wpm
• Exceptional customer service skills
• Working knowledge of IDX
• Strong public speaking skills
• Strong presentation skills
• Strong written communication skills

Education and/or Experience:

• 4 year college degree preferred
• Minimum of 3 years of HMO/IPA experience in Provider Relations or Contracting
• IPA Operations experience strongly recommended

If you are interested in an above position, please send your resume and salary history to: hr@prospectmedical.com. Also please include the job title in the subject line.