Provider representative

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization.

Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the Provider Relations Representative I position in the range of $26.73 - 34.70 / Hour

Hybrid Position

Definition

Under general direction of the department supervisor, the Provider Relations Representative is responsible for assigned duties and activities in the Provider Relations Department to ensure an appropriate network of health care providers is available to the members of Kern Health Systems (KHS).

Distinguishing Characteristics

This position is responsible for the assigned duties in the provider relations functions for a Knox-Keene licensed health care maintenance organization which includes daily contact with network providers to establish and maintain relationships beneficial to the Plan, the Providers and the Members.

Essential Functions

• Professional, ethical and respectable representation of Kern Health Systems to the Provider community.
• Work directly with providers and staff to develop and facilitate efficient health care delivery network, resolve issues, and provide continued provider support.
• Under supervision / direction of Supervisor, negotiates and maintains effective and efficient systems and procedures for recruiting, and contracting with a full range of health care providers.
• Assists with conducting individual / group provider orientation sessions and follow-up orientations with both prospective provider groups and participating physicians.
• Assists with developing, updating and disseminating a provider administrative manual to ensure that providers and their administrative staff have up-to-date plan information and are familiar with the KFHC policies, procedures and operations.
• Types provider related and departmental correspondence.
• Conducts periodic provider satisfaction surveys and reports results to supervisor.
• Possess, and demonstrate full understanding of the various provider contracts maintained by KHS.
• Responsible for maintaining and documenting all types of provider contacts in provider files.
• Assists with analyzing various reports to monitor provider activity and to identify provider problems. This may include assisting with developing and implementing necessary action plans.
• Utilizes personal computer for tracking detailed data, performing data analysis, generating reports, documentation and project evaluation purposes.
• Assists in the development and preparation of various state required reports, which may include network analysis, statistical preparation and mapping skills.
• Possess working knowledge of KHS Policies and Procedures.

Other Functions

• Assists management staff in completing provider relations related projects as assigned.
• Interfaces with other departments in the development, preparation and distribution of provider and / member satisfaction surveys.
• Performs other job related duties as assigned.
• Travel independently to conduct provider visits with own reliable transportation.
• Adheres to all company policies and procedures relative to employment and job responsibilities.

Employment Standards

Education : High School Diploma from an accredited school or equivalent and completion of 60 semester units or 90-quarter units from an accredited college or university.

Industry related training may be accepted as substitution.)

Experience : Three (3) years provider relations or medical staff experience preferred. (Two (2) years of related managed care experience may be substituted for each year required.

Relational database experience, windows environment preferred.

Knowledge of : Health maintenance organization provider relations, recruiting and credentialing requirements and procedures;

managed care contracting methods; medical reimbursement methodologies.

• Ability to : Communicate effectively, both verbally and in writing; adapt to a rapidly evolving work environment; work independently and manage multi-task responsibilities;
• intervene in crisis situations on behalf of the health Plan or providers; deal with difficult people, prioritize workload, make decisions, resolve provider relations concerns;

prepare and organize reports and surveys regarding provider relations activities and statistics; effectively use various computer programs.

Other : Required travel up to 40%. Possession of valid California Driver's License and proof of valid State required auto liability insurance.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

Other details

• Pay Type Hourly
• Min Hiring Rate $26.73
• Max Hiring Rate $34.70
• Travel Required No
• Travel % 40
• Telecommute % 0
• Required Education High School

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Last updated : 2024-02-25