Provider Relations Coordinator

Astiva Health•Orange, CA

About The Position

Astiva Health, Inc., located in Orange, California, is a healthcare provider specializing in Medicare and HMO services. The Provider Relations Coordinator provides administrative and operational support to the Provider Relations Department under the general supervision of the Provider Relations Manager and VP. The role involves routine and semi-routine tasks requiring thorough knowledge of organizational policies and procedures. The Coordinator builds and maintains relationships with providers, supports provider performance and compliance, responds to provider inquiries, and coordinates communications and meetings with IPAs and medical groups. The position also supports network development, marketing events, provider-directory accuracy investigations, and special projects. Travel between service counties is required.

Requirements

At least two years of experience in a Medical Group/IPA, managed care, and HMO.
At least one year of experience in provider network development or management, account management, or provider relations within a managed care organization.
In-depth knowledge of contracting, reimbursement, credentialing, and operations.
Proficiency with MS Office Suite and other database software.
Knowledge of Medicare regulations, NCQA, and HIPAA compliance.
Ability to travel between service counties.
Ability to read and interpret documents, write routine reports and correspondence, and speak effectively before groups and customers or employees.
Ability to perform basic arithmetic and calculate rates, ratios, and percentages, and to interpret bar graphs.
Ability to solve practical problems and interpret instructions in written, oral, diagram, or schedule form.
Regular and consistent attendance.

Responsibilities

Visit assigned providers routinely to develop trusted relationships, maintain communication, support engagement with company initiatives and deadlines, and promote compliance with applicable regulations and company policies.
Collaborate with internal departments to improve provider performance in Quality, Risk Adjustment, and Operations, including claims and encounters.
Communicate with PCPs, specialists, and contracted vendors or services through in-person and virtual visits, calls, and email; resolve issues promptly and provide excellent customer service.
Work with internal departments to help providers with questions about claims, authorizations, benefits, and other issues.
Work with assigned IPAs to provide timely and accurate information about company initiatives, services, programs, policies, procedures, and quality measurements.
Assist the Manager in coordinating quarterly or as-needed meetings with IPAs and medical groups.
Assist with development of the Dental and Acupuncture Direct Network.
Coordinate with the Sales/Marketing Department to organize and participate in marketing events as needed.
Review and verify reported Provider Directory inaccuracies and lead their investigation and resolution.
Participate in special projects and assignments as required.
Perform other duties as assigned.