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Provider Relations Coordinator

Monterey Park, CA 91755

Employment Type: Contract Position: Administrative/Clerical/Support Branch:

Job Description:

Responsible for building and maintaining effective provider relationships with IPA/Medical groups, PPO physicians, and hospitals. This entails services in the operational and compliance aspects of provider contracts. Daily interface with providers to effectively resolve service issues in a timely manner is a requirement of the job.

  • Deliver education and training effectively, but relies on their manager and higher level peers to improvise provider education messaging and strategic dealings with their assigned network
  • Coordinate escalated claim disputes and all necessary research timely and effectively, but can rely on their manager and higher level peers in setting action plans to analyze and resolve root cause
  • Implement or coordinate at least one geo-regional strategy that will result in operational efficiencies, with support and guidance from manager
  • Coordinate data extracts and data analysis interpretation in preparation of reports aimed to determine necessity of rate increases to retain key PPO providers, with support and guidance from peers or manager
  • With guidance with from higher level PRCs, the Associate level is required to work closely with its assigned IPA/Medical Group to ensure it is compliant with Access and Availability requirements
  • Complete Transition and Disengagement Reports required by Department of Manage Health care when IPAs/Medical Groups or Hospitals submit termination notices
  • The job requires minimum level of autonomy in decision making since the PRCs main customers (providers), need to rely on the PRCs for answers to issues that need immediate resolution

Requirements

  • Claims Knowledge
  • Medical Billing Knowledge
  • Medical Terminology knowledge
  • Computer Literacy and Proficiency
  • Bachelor's Degree preferred
  • Three years of experience in Healthcare Industry (Customer Service, Appeals, Sales)

Job Type: Full-time

Salary: $22.00 to $23.50 /hour

Nora Kawaguchi
Recruiter

As a South Carolina native, Nora always allows her southern hospitality to shine through all of her encounters. She brings a passion for building meaningful relationships and an enthusiastic personality to the Wollborg Michelson Recruiting team! Nora has a unique background in the performing arts, administrative/ HR support and teaching English in a foreign country. She could be described as adventurous, motivated and a great listener. Nora believes that a smile and positivity go a long way and making a difference in the lives of others is where she truly thrives! 

In her “off” time, Nora is the Sacramento region youth dance coordinator for an international organization that promotes world peace. When she’s not teaching, she is dancing on a semi-pro Latin dance team. Let’s just say that Nora really LOVES to dance! 

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