Provider Relations Represenitive

    Partnership HealthPlan of California
    Eureka, California, Eureka, CA 95501
    Refer friends, get paid!

    Job Description

    We have a full-time opening for a Provider Relations Represenitive.

    Must be able to work various shifts per week.

    • Must have 3 or more years experience.
    • Must have a high school diploma or equivalent.
    • Be authorized to work in the United States.
    • Must have reliable transportation.
    • Background check required.


    To recruit, retain, and provide customer service to PHC contracted provider network, including but not limited to Physicians and ancillary Providers.

    - Recruits new physician and ancillary providers, conducts office orientations.
    - Trains office and provider staff on managed care concepts, PHC policies and procedures.
    - Investigates and responds to providers concerns.
    - Maintains provider contract and correspondence files.
    - Composes correspondence, conducts research and prepares reports as needed.
    - Uses automated database and tracking systems to retrieve and update information and generate reports.
    - Serves as a neutral liaison between providers and PHC departments in resolving issues and problems.
    - Prepares claims activity reports to assist with provider service and training.
    - Develops Provider Newsletter articles, bulletins and updates for the Provider Manual as requested.
    - Resolve member complaints related to providers.
    - Assists with disposition of provider appeals and grievances.
    - If a telework position, comply with all PHC telework policies and procedures.

    - Participates in special projects and assignments as required.


    Education and Experience
    Bachelor's degree in Healthcare, Marketing, Public Relations or related
    field; minimum three (3) years healthcare, marketing or public relations
    experience in a managed care environment preferred; or equivalent
    combination of education and experience.

    Skills, Licenses and Certifications
    Working knowledge of business software applications. Knowledge of
    managed care concepts, policies and procedures. Must have access to
    own reliable vehicle with proof of insurance coverage in conformity with
    State law. Valid California driver's license.

    Performance Based Competencies
    Excellent oral and written communication skills. Excellent organizational
    skills with ability to prioritize assignments, maintain accurate records,
    files and documentation. Ability To use good judgment in making
    decisions within scope of Authority and to handle sensitive issues with
    tact and diplomacy.

    Work Environment And Physical Demands
    Ability to use microcomputer keyboard. More than 30% of work time is
    spent at a video display terminal. When required, ability to move, carry
    or lift objects weighing up to 35 lbs. Ability to operate a vehicle used for
    company business.

    All Healthplan employees are expected to:

    - Provide the highest possible level of service to clients;
    - Promote teamwork and cooperative effort among employees;
    - Maintain safe practices; and
    - Abide by the Healthplan's policies and procedures, as they may from time to time be updated.

    The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

    Posting ID: 34836130Posted: 2020-07-14