Provider Relations Coordinator

Astiva Health•Orange, CA

3d•$25 - $28

About The Position

Astiva Health, Inc. is a healthcare provider specializing in Medicare and HMO services. Under the general supervision of the Provider Relations Manager and VP, the Provider Relations Coordinator performs routine and semi-routine tasks requiring thorough knowledge of organizational policies and procedures. The position provides administrative and operational support to the Provider Relations Department and helps maintain relationships and communication with providers, IPAs, medical groups, and contracted vendors.

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 in a managed care organization.
In-depth knowledge of contracting, reimbursement, credentialing, and operations.
Proficiency with Microsoft 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 organizational customers or employees.
Ability to perform basic arithmetic and compute rates, ratios, and percentages, and to draw and interpret bar graphs.
Ability to solve practical problems and interpret written, oral, diagrammed, or scheduled instructions.
Regular and consistent attendance.

Responsibilities

Visit providers as assigned to build trusted relationships, maintain communication, support engagement with company initiatives, promote compliance, and help providers meet deadlines.
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 claims, authorizations, benefits, and other inquiries.
Coordinate 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 developing 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 investigations and resolution.
Participate in special projects and assignments as required.
Perform other duties as assigned.