PACE HP - Provider Relations Specialist (Central Valley PACE - Ceres Whitmore)

Available Staff Positions•Ceres, CA

16h•$26 - $27•Onsite

About The Position

The Provider Relations Specialist will serve as a key liaison between the organization and healthcare providers within the PACE (Program of All-Inclusive Care for the Elderly) model. This role is responsible for fostering and maintaining strong, positive relationships with providers, ensuring seamless care coordination, and supporting the organization's mission to deliver high- quality, integrated healthcare services for seniors. Located at Central Valley PACE – Ceres, CA Schedule is Monday – Friday, working from 8:00am – 5:00pm Compensation: $25.87 – $27.16 an hour

Requirements

Valid California Driver’s License, acceptable driving record and vehicle insurance.
Must have strong communication and presentation skills, both oral and written, analytical and team leading skills.
Proficient in Microsoft Office applications; advanced Microsoft Excel experience required.
Proven analytical ability, problem solver, collaborate well in a team environment and demonstrate the ability to learn quickly.
Associates degree in business administration, healthcare administration or related field; or two (2) years of equivalent relevant work experience in lieu of degree.
Minimum two (2) years progressively responsible experience with Health Plan processes, Provider relations, contracting, compliance, and reporting.
Current BLS CPR Card certified by the American Heart Association.

Nice To Haves

Bilingual: Spanish/English preferred.
Familiarity with Centers for Medicare & Medicaid Services & Health Plan Management System information technology within CMS and/or HPMS is preferred.

Responsibilities

Serve as the main point of contact for contracted healthcare providers, including physicians, specialists, and other service providers.
Foster strong, long-term relationships with network providers to ensure satisfaction and high-quality care delivery for PACE participants.
Regularly assess provider performance, address concerns, and collaborate to resolve any issues or barriers to care.
Educate providers about the PACE model, program goals, and participant needs, ensuring a shared understanding of the service delivery model.
Conduct regular training sessions to ensure providers are informed of PACE policies, procedures, and best practices.
Keep providers updated on any changes to regulations, reimbursement practices, and organizational guidelines.
Assist in the development, negotiation, and execution of provider contracts, ensuring terms align with the PACE model's objectives and regulatory requirements.
Monitor provider compliance with contract terms and letter of agreement (LOA).
Support the contract renewal process, identifying opportunities for growth, efficiency, and improved service delivery.
Assist with the credentialing process for all providers, ensuring adherence to the organization’s policies and regulatory requirements.
Manage CAQH (Council for Affordable Quality Healthcare) provider profiles, ensuring they are up-to-date and compliant with industry standards.
Retain and organize monthly credentialing files, maintaining compliance with regulatory standards and ensuring the provider network is audit-ready for CMS (Centers for Medicare & Medicaid Services) audits.
Ensure that all credentialing documentation is complete and accurate in preparation for regular CMS audits, adhering to compliance requirements and guidelines.
Track provider performance metrics, including patient outcomes, satisfaction scores, and service delivery timelines.
Assist with reporting provider performance to leadership, identifying areas for improvement and suggesting actionable solutions.
Ensure accurate documentation and reporting of all provider-related activities.
Act as a problem solver for both providers and the PACE team, addressing any issues related to service delivery, claims, or provider concerns.
Use critical thinking to resolve conflicts or challenges related to participant care, provider performance, or operational processes.