Provider Relations Representative Jobs in USA with Visa Sponsorship

Overview:

Supervise daily operations and provide leadership, support, and direction to assigned Provider Relations Representative staff. Ensure the highest level of customer service is a priority of PR staff. Monitor department goals and meet deadlines. Recruit and retain Provider network.

Responsibilities:

• Supervise daily operations of assigned PR Representatives.
• Provide leadership, direction, support, and daily supervision to staff.
• Promote professionalism, positive attitudes, teamwork, and fun in the workplace.
• Conduct weekly staff meetings.
• Provide weekly and/or monthly performance feedback to PR Representative staff.
• Conduct annual performance evaluations.
• Provide staff development, monitor staff performance, and provide counseling.
• Monitor REP visit logs, score cards, department goals, and ensure compliance.
• Interview and participate in selection of PR Representative staff.
• Resolve provider inquiries and problems.
• Assist with resolution of provider expressions of dissatisfaction, appeals, and grievances.
• Develop provider training materials in collaboration with SR Manager of Network Education and Credentialing.
• Supervise provider survey activities for DHCS, NCQA, and other Regulatory agencies. Ensure timelines are met, develop corrective action plans.
• Attend early morning and late evening provider/PHC meetings.
• Coordinate new provider recruitment and contracting activities with Contracts staff as needed.
• Participate in special projects and assignments, ensure deadlines are met.
• Coordinate and monitor provider network trainings.
• Ensure PR Representatives meet provider visits goals, monitor issues identified during visits, and develop action plans with PR Representatives to address problems.
• Participate in DHCS annual audits as assigned.
• Assist with documentation to meet NCQA requirements.
• Active member of the PHC CERT team.
• Participate in PHC Team and Dept. goals.
• Ensure daily operations and servicing goals are met if REP staffing issues occur.
• Facilitate the scheduling of NR/SR combined REP meetings.
• If applicable, retain the day-to-day servicing of the assigned county provider network.

SECONDARY DUTIES AND RESPONSIBILITIES:

Back up to Director or Senior Provider Relations Representative Manager as directed.

QUALIFICATIONS:

Education and Experience

Bachelor’s degree in Healthcare, Marketing, Public Relations, or related field; minimum three (3) years in healthcare, marketing, or public relations experience in a managed care environment preferred; or equivalent combination of education and experience. Two (2) years of experience as a Provider Relations Representative.

Special Skills, Licenses and Certifications

Working knowledge of business software applications. Knowledge of managed care concepts, policies, and procedures. Ability to disseminate MediCal policies and procedures. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communication skills. Excellent organization skills with the ability to prioritize assignments, maintain accurate records, and meet deadlines. Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 30% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 35 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$93,690.86 - $117,113.58

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.