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Provider Relations Representative

Company: Apollo Medical Holdings, Inc.
Location: El Monte
Posted on: May 2, 2021

Job Description:

SUMMARY: Provider Relations RepresentativeThe Provider Relations Representative is responsible for field and office activities in educating and supporting the IPA's provider network. The PR representative will be work closely with contracted providers on managed care operations, oversight of assigned region, work with Upper Management to report network needs and how to further enhance the organization.An individual with at least three (3) years experience in managed care in handling provider contracting or provider network scope of services. The individual must have an understanding of Managed Care operations (ie, patient referrals, claims process, eligibility information, contracting, HEDIS, HCC/Star etc.)ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:* Must be able to have effective interaction with all Providers.* Must be able to problem solve and identify ways to address provider network issues effectively.* Understanding of key managed care operations, specifically UM, Claims, Eligibility/Capitation, HEDIS/STAR measures.* Proficient in English* Traveling frequently to assigned region is required.* Promote the integrity of the IPA.* Provide support and ongoing education to contracted providers and their office staff regarding IPA policies, procedures, and contractual obligations to ensure compliance with state and federal regulations.* Develop collaborative relationships with Physicians, clinic organizations, Health Plan Representatives and affiliated hospital staff.* Must be able to research and understand authorizations, claims, eligibility, and compliance items raised by physician practices or health plan partners.* Participation in new business development projects.* Help facilitate monthly or quarterly meeting with clinic, hospital, and/or health plan partners.* Participate and conduct provider network administration functions including but not limited to: status changes, member transfers, Health Plan and inter-departmental reporting, distribution of reports to contracted providers, etc.* Attend monthly Provider Network and/or Operations Meeting, Quarterly Hospital Joint Operation Committee Meetings, and Quarterly Health Plan Joint Operation Committee Meetings.* Ability to handle member/provider concerns in an empathetic and caring manner.* Must be able to travel to Network Medical Management, Inc. offices in Alhambra, CA and other NMM facilities as needed.QUALIFICATIONSTo 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.EDUCATION and/or EXPERIENCEAn undergraduate degree from an accredited institution of higher learning required; or minimum of three (3) years of experience in the managed care industry with a focus on provider relations operations.

Keywords: Apollo Medical Holdings, Inc., El Monte , Provider Relations Representative, Other , El Monte, California

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