Provider Relations Manager

High Desert Pace Inc•Victorville, CA

2d•$87,000 - $98,000

About The Position

The Provider Relations Manager develops and maintains service relationships with PACE participants, physicians, outside physicians, and administrators. The role responds to electronic and direct inquiries about policies, reimbursement rates, patient referrals, and eligibility, and supports the effectiveness of the PACE Program through special projects such as telehealth, process improvement, community outreach, and community engagement. The manager follows organizational and departmental policies, strives for high-quality work, completes assignments in a timely manner, and represents the organization professionally. The role also works with Compliance on credentialing new and renewed contracts. Provider relations work includes provider engagement and training, scheduled service visits with targeted providers, network capability monitoring, limited-service contract negotiations, and resolving participant and PACE issues. The position supports provider education and non-routine claims issues, researches and recommends resolutions for provider disputes, and helps network providers use available tools to confirm eligibility, submit claims, and check payment. The manager oversees Telemedicine implementation between the PACE Program, participants, and specialty physicians, and provides participant education and support for the service line. The position also performs general administrative duties, including responding to calls and emails, communicating messages to the Program Director or appropriate staff, managing office supplies and equipment with prior approval, maintaining schedules, and arranging meetings and conferences. It requires maintaining confidentiality, delivering excellent customer service, participating in assigned meetings and projects, supporting center policies and procedures, accepting other related duties, and flexibility in work schedule. Use of a personal vehicle may be required.

Requirements

At least an associate's degree in business, healthcare, insurance, or a related field; experience may be considered in lieu of education.
At least three years of demonstrated experience in the healthcare field.
At least one year of documented experience working with a frail or elderly population.
Proficiency with computer skills and Microsoft Office applications, including Word, Excel, Access, PowerPoint, and Outlook; the posting also lists Word, Excel, PowerPoint, Publisher, and Outlook.
Knowledge of general office procedures, equipment, and filing systems.
Ability to communicate effectively orally and in writing.
Ability to quickly learn department policies, procedures, goals, and services.
Attention to detail and accuracy.
Ability to change priorities regularly.
Ability to speak, read, write, and understand English effectively at a level appropriate for the job.
Ability to access all areas of the center throughout the workday.
Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; assistance from another qualified employee is required when lifting or transferring objects over 25 pounds.
Ability to perform constant hand grasping and finger dexterity, frequent sitting, standing, walking, and repetitive leg and arm movements, and occasional bending, forward and overhead reaching, squatting, and kneeling.

Nice To Haves

A bachelor's degree is preferred.

Responsibilities

Serve as a liaison between providers and PACE participants.
Receive and respond to external provider- and participant-related issues.
Develop workflows, strategies, and special projects to meet participant care needs.
Oversee the Telemedicine implementation plan between the PACE Program, participants, and specialty physicians.
Provide participant education and support for the Telemedicine service line.
Ensure Telemedicine is effective and maximize its use for clinical and educational services.
Represent and promote knowledge of PACE in the community.
Make travel arrangements as needed, maintain appointment schedules and calendars, and arrange meetings and conferences.
Manage office supplies and equipment and order departmental supplies with prior approval.
Answer and respond to phone calls and emails, and communicate messages and information to the Program Director or appropriate staff member.
Maintain confidentiality and provide excellent customer service to program enrollees, their families, or designated representatives.
Engage and train providers, conduct regularly scheduled service visits with targeted providers, monitor network capability, negotiate limited-service contracts, and resolve participant/PACE issues.
Respond to general provider contract inquiries.
Address provider education needs and non-routine claim issues; research, analyze, and recommend resolutions for provider disputes as needed.
Conduct provider outreach, training, and guidance to help network providers independently confirm eligibility, submit claims, and check payments using available tools.
Attend and participate in staff meetings, in-services, projects, and committees as assigned.
Adhere to and support center practices, procedures, and policies, including assigned break times and attendance.
Accept assigned duties cooperatively and perform other related duties as assigned.
Work a flexible schedule of hours.
Use a personal vehicle if required.