Provider Office Support

JOB TITLE: PROVIDER SERVICE REPRESENTATIVE

DEFINITION: Liaison between health plan, providers, members and IPA.

POSITION SUMMARY:

  1. The Provider Services Representative reports to the Provider Network Manager.

  2. Individual must be knowledgeable in managed care and managed care activities.

  3. Must have effective listening and verbal communication skills, and must be knowledgeable of all internal department processes and operations.

  4. Must be knowledgeable of each provider, provider staff, and patient-oriented. Individual must represent Advanced Medical Management/ IPA as a positive and professional company

RESPONSIBILITIES:

  1. Responsible for the initial orientation of newly contracted providers

  2. Responsible for ongoing provider staff education and service visits

  3. Cerecons set-up and training

  4. Delivery of CAPE forms, if necessary

  5. Maintain regular contact with key providers

  6. Serve as a liaison to internally resolve complex issues

  7. Educate providers on new protocols, policies and procedures

  8. Participate in and prepare for marketing events conducted by outside organizations and/or events organized by the IPA

  9. Supports the IPA operations in proactive development of effective and collaborative relationships with all primary care and specialty care providers to successfully service and retain business

  10. Responsible for organizing provider office orientation meetings

  11. Performs other duties as required

QUALIFICATIONS AND REQUIREMENTS: 

  1. Demonstrate excellent business development skills

  2. Knowledge of Medicare managed care and/or Medi-Cal regulations, policies and procedures

  3. Demonstrates technical and operational knowledge and expertise

  4. Cultivates positive professional and interpersonal relationships with health plans, providers and IPA

  5. Minimum 2 years experience in the health care industry with a solid customer service problem-solving background

  6. Excellent verbal and written communication skills

  7. Team-building and presentation skills

  8. Effective organizational skills