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Provider Contracting Service Representative

Date: Apr 27, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 4833 

 

Position Summary/Position

 

Under the direction of the Manager, Provider Contracting Service the Provider Contracting Services Representative (PCSR) is responsible for developing and maintaining strong and consistent relationships with IEHP Direct Ancillary Providers, SNFs, Hospitals, and Hospital based Providers. The PCSR will anticipate, record and respond to IEHP Direct Ancillary Provider needs. The PCSR will represent IEHP in a friendly and professional manner. Routinely communicate organizational policies, procedures, processes, regulatory updates, anticipate and respond to Provider educational needs and conduct Provider trainings. Coordinate with Providers to meet IEHP quality metrics, service goals and compliance standards.

Major Functions (Duties and Responsibilities)

 

1. Communicate with Providers by providing information and assistance, including Provider visits and/or one-on-one in-services/trainings.
2. Act as a Provider Advocate.
3. Answer questions and assist Member Services Representatives and Case Management staff, and the Provider Call Center to resolve Member and Provider cases.
4. Lead person for coordinating and resolving provider grievances.
5. Assist all departments with complaints or issues within the Ancillary Provider Network and resolve as appropriate.
6. Assist Providers with interpreting eligibility and reimbursement queries as well as Member complaints or issues.
7. Assist with the development of the Provider Policy and Procedure Manual as requested.
8. Visit all new directly contracted Ancillary Providers and Provider a New Provider Training.
9. Visit all directly contract Ancillary Providers on an annual basis.
10. Assist the Contracts department as needed.

Experience Qualifications

 

A minimum of three (3) or more years direct experience with Managed Care, working knowledge of Medical Group/ IPA and HMO operations.  Three or more years experience with customer service.

Education Qualifications

 

Bachelor's degree from an accredited institution required.

Drivers License Required

Yes, must have a valid California Driver's License.

Skills Requirement

 

Microcomputer applications (Microsoft Word and Excel, Access preferred) for use in all aspects of an office environment. Strong organizational skills, excellent written and verbal communication and interpersonal skills. Skilled data input.

Abilities Requirement

 

Possess telephone courtesy with a high level of patience.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

Must have a valid California driver’s license.

Data entry involving computer keyboard and screens, automobile travel within the IEHP service area, distribution of reports and supplies to outside provider offices. Must be able to lift, push or pull up to 25 lbs.  Back support belts must be worn when lifting, pushing or pulling items.

 

Starting Salary: $50,835.20  - $64,792.00  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles