Provider & Member Engagement Coordinator

All Care To You • Orange, CA

23d

About The Position

The Provider & Member Engagement Coordinator will support the Provider Engagement and Customer Service Teams. This role involves assisting with ACTY portal user management, onboarding providers, maintaining provider and vendor data, and developing policies and resources to improve provider engagement. The Coordinator will help identify opportunities for enhanced provider relationships, participate in developing communication materials, and support various member outreach and educational initiatives. Additionally, the role includes troubleshooting operational issues, assisting with training and presentations, and ensuring provider satisfaction through proactive communication and relationship management. The Coordinator will work closely with internal teams to ensure seamless operations and contribute to achieving organizational goals such as the 5-Star performance standard.

Requirements

• 1-2 years of experience in the healthcare industry navigating relationships around providers and insurance networks is preferred
• Must have an excellent working knowledge of ICD- 10, CPT, and HCPCS coding classification systems and medical terminology
• Knowledge of Microsoft Office Suite
• Must be organized and detail-oriented.
• Excellent verbal and written communication skills are a must.
• Strong leadership and problem-solving skills.
• Ability to communicate clearly and concisely, self-starter, deadline and result driven.
• Ability to produce standard and ad-hoc reports accurately and of high quality.
• Strong organizational and follow-up skills
• Ability to prioritize and complete tasks with a high level of efficiency and attention to detail.
• Dependable and able to work independently.
• Be resourceful and willing to take extra steps to ensure most ultimate outcome.

Nice To Haves

• Managed Care experience preferred
• Provider Relations experience preferred

Responsibilities

• Assist the Customer Service Team with ACTY Portal User management and portal trainings.
• Provider onboarding review and readiness assessment meetings
• Provider and Vendor data entry adds, changes and updates
• Assist the development of ACTY’s policies and procedures for engaging provider partners, including advancing best practices for engagement and issue resolution build an internal resource suite to support providers in all markets.
• Assist the development of ACTY’s provider resources and tools, including provider portal, educational materials, provider manual, and others as appropriate.
• Identify opportunities to enhance our relationship with providers including but not limited to the development of new programs, tools, and services.
• Assist with the development and distribution of all member communications and collateral materials, including member education, member advocacy, support enrollment and eligibility functions, health education, analysis of action plan disenrollment rates, grievance tracking and reporting, and member satisfaction.
• Utilize zoom, phone calls, or conduct site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information, and review all quality Cozeva information.
• Collaborate and assist patients, providers, and team members reach the standard of 5 STARS.
• Assist with member outreach.
• Achieves goals to establish consistent and strong relationship with provider offices.
• Fostering and Maintaining proactive positive relations throughout the provider network by communicating with provider offices through face to face visits, letters, telephone calls, faxes or emails, sharing data and information about the provider’s practice.
• Assist with provider operational issues for timely resolution.
• Assist in the creation and maintenance of department training materials.
• Preparing and delivering verbal presentations in a group or one-on-one setting to network providers and their staff.
• Serve as a liaison between the client and ACTY’s internal departments. Troubleshoot escalated issues to meet the client’s expectations
• Performing other duties and special projects as assigned.

Benefits

• ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees.
• Additional employee paid coverage options available.
• We also offer paid holidays, birthday off, and unlimited PTO as well as a 401k plan.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed