PROVIDER PRACTICE SUPPORT ADVISOR
About The Position
The Provider Practice Support Advisor serves as the primary liaison and relationship owner for an assigned portfolio of provider practices. The role supports provider engagement, education, quality improvement, and operational performance by coordinating resources and facilitating timely resolution of provider needs. The Advisor provides a consistent point of contact while partnering with Quality, Risk Adjustment, Clinical, Claims, Utilization Management, Credentialing, Contracting, Compliance, and other specialized teams, which retain responsibility for their respective functions. This position is based at 7311 Greenhaven Drive, Sacramento, California, and operates in a professional office environment. It routinely uses computers, phones, photocopiers, scanners, and filing cabinets. Travel may be required up to 50% of the time in the greater Sacramento Area. The role is full-time and day shift.
Requirements
- High school diploma or GED.
- Active and unrestricted driver’s license.
- Working knowledge of health plan operations, including claims, authorizations, referrals, credentialing, contracting, utilization management, and quality improvement programs.
- Strong written and verbal communication, interpersonal, relationship-management, organizational, and problem-solving skills.
- Ability to independently manage multiple provider relationships, priorities, and competing deadlines in a dynamic, fast-paced environment.
- Ability to establish and maintain effective professional relationships while demonstrating professionalism, confidence, sound judgment, and sincerity.
- Strong planning, time-management, and follow-through skills, with excellent attention to detail and the ability to maintain accurate, complete, and timely documentation.
- Ability to work effectively independently and collaboratively within a team environment.
- Ability to provide and receive constructive, job- and industry-related feedback professionally.
- Ability to exercise sound discretion, maintain confidentiality, and handle sensitive information appropriately on a need-to-know basis.
- Commitment to excellent customer service and representing the Company professionally.
- Commitment to the organization’s mission, values, and service standards.
- Intermediate proficiency in Microsoft Word, Excel, PowerPoint, Visio, and email applications.
- Ability to quickly learn and effectively use new software, technology, and healthcare-related systems.
Nice To Haves
- Experience in provider relations, provider services, managed care, healthcare operations, or quality improvement.
- Bachelor’s degree in healthcare administration, business, public health, nursing, or a related field; equivalent relevant experience may be considered.
- Typing speed of 40 words per minute or greater.
Responsibilities
- Serve as the primary relationship and coordination resource for assigned provider practices.
- Conduct provider meetings, outreach, education, and practice support activities.
- Support HEDIS, Stars, quality measures, care-gap closure, and other health plan or organizational initiatives.
- Review available provider performance information and communicate opportunities requiring provider action.
- Educate providers and office staff regarding health plan requirements, authorizations, referrals, claims processes, documentation, system tools, and operational workflows.
- Coordinate provider onboarding, orientation, system access, and training.
- Assist providers with operational issues involving claims, credentialing, contracting, utilization management, compliance, grievances, referrals, and authorizations.
- Route issues to the appropriate internal department and maintain provider communication and follow-through through resolution.
- Identify recurring provider barriers and escalate complex performance or workflow issues to the appropriate internal resource or Senior Practice Coach.
- Maintain accurate documentation of provider interactions, education, outstanding issues, and follow-up activities.
- Support provider satisfaction, engagement, and successful participation in organizational and health plan programs.
- Perform related duties consistent with the scope and intent of the position, including regular attendance and travel as required.
- Enforce company policies and safety procedures.
- Update job knowledge through educational opportunities, professional publications, professional networks, and professional organizations.
- Maintain IPA and Health Plan compliance standards.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
