Job Description

Provider Relations Specialist - Remote

Location:

REMOTECalifornia

Date Posted:

5/18/2021

Employment Type:

Consulting

Recruiter:

Alex Kyllingstad

Recruiter Email:

alex.kyllingstad@avidtr.com

Job ID:

JN -052021-14536

Job Description

AVID Technical Resources is seeking a remote Provider Relations Specialist  for our Health Care client in West Los Angeles

The Provider Relations Specialist (PRS) acts as an intermediary between the incumbent organization, health plans, and their provider network to actively research and resolve provider complaints and issues. As a member of the Provider Relations Team, the PRS...
  • Receives incoming provider and member inquiries via telephone, e-mail or fax, identifies potential trends and follows-up with providers, members and internal departments ensuring identified problems have been resolved
  • Works as a team member with providers, provider’s office staff and all departments
  • Conducts provider orientations, communication of policies, procedures, and regulatory compliance matters as it impacts the providers
  • Adheres to NCQA, State, Federal and other Regulatory agency standards as it pertains to the responsibilities of the position
  • Ensures the accuracy of provider data entered into the provider database as well as participating in the activities required for credentialing oversight as defined by departmental policy
  • Is accountable for consistently maintaining production and quality standards in accordance with departmental policy.
Core Requirements
  • High school diploma, GED or equivalent.
  • Minimum of 3 years provider relations experience in an HMO environment (i.e. MSO, IPA or health plan).
  • Working knowledge of managed care industry and its’ related processes as well as provider paneling and flow of related information. Familiarity with provider credentialing requirements a plus.
  • Must have strong problem solving skills. Ability to analyze problems and formulate plans, solutions and a course of action.
  • Excellent organizational and time management skills, including the ability to handle multiple conflicting priorities simultaneously. Strong ability to prioritize.
  • Proficient computer skills including Microsoft Excel and Word. Familiarity with Microsoft Access a plus. Competence in navigating the Internet.
  • Working knowledge of managed care processing systems (i.e. EZ Cap, Diamond, IDX).
  • Team orientation and ability to work effectively across functional areas of the company.
  • Strong interpersonal, verbal and written communication skills. Ability to communicate well with internal and external customers, providing timely and accurate information as needed.
  • Ability to travel locally with personal means of transportation
  • Ability to work Business hours 8:00am – 5:00pm.
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