Essential Functions and Responsibilities of the Job
Responsible for supervising the Provider Relations staff, and for developing and maintaining policies and procedures directly related to The Provider Relations department.
Handles all aspects of staff management, including but not limited to: interviewing, hiring, evaluations, and resolution of issues.
Oversees day to day operations including but not limited to the assignment and distribution of work.
Oversees staff training, and identifies the need for ongoing staff training, as well as the application of lean principles to ensure proficiency and competence amongst staff.
Creates, manages, and communicates reference guides, standard work, and policies and procedures directly related to Provider Relations staff.
Responsible for overseeing the Provider Relations staff is maintaining strong relationships with network providers and providing ongoing education and training with a high level of customer service in a timely manner.
Interacts with internal and external providers, health plans, hospitals and regulatory agencies to resolve provider relations issues.
Oversees and maintains network intranet and internet sites, Contracted Provider Manuals, communication pieces, directories, and rosters.
Ensures the timely preparation of budgets, reports, and provider satisfaction surveys.
Assists and supports the Director in budget preparation and department compliance with budget.
Oversees Health Plan Adds, Changes, and Terminations, and the maintenance of provider demographic information listed with the health plans.
Responsible for the timely processing of check requests and approving check requests as needed for staff.
Assists with problem solving and improvement of managed care portal including training, provisioning, workflow and functionality.
Problem solving of provider issues, health plan issues, and billing issues as they relate to health plan submissions.
Perform any additional/miscellaneous duties (not inclusive to job description) as requested by the management within the scope of knowledge/ability.
Essential Job Outcomes
First line of contact for all interdepartmental requests related to provider relations issues.
Reports any dissatisfaction among providers, escalating concerns to management as appropriate, and resolves within limits of authority, reporting issue and resolution to the provider relations management team or supervisor.
Primary coordinator/trainer of portal implementation and responsible for increasing portal enrollment.
Serve as in-house PR rep, staffing provider relations line and assisting other departments in resolving provider issues.
Coordinates with customer service department to resolve provider issues.
“Other duties as assigned”
Minimum of 3-5 years relevant healthcare experience. Management experience required.
Bachelors degree or commensurate experience.
Strong verbal and written communication skills and the ability to interact effectively with a diverse group of staff, executives and providers.
Epic or equivalent Managed Care electronic medical record system and provider portal applications knowledge preferred.
Excellent computer skills and proficiency with Microsoft applications including Word, Power Point, Excel, and Outlook is a must.
Experience with Microsoft Access is also preferred.
Experience with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred.
High School Diploma or equivalent (Required)
Bachelor’s Degree or equivalent (Preferred)
Internal Number: MEM003571
About MemorialCare Medical Foundation
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.