Provider Workflow Support Specialist

Date: Aug 4, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

 

 

Position Summary/Position

 

The Provider Workflow Support Specialist works as a care facilitator who works closely with Provider Relations Management Team to develop and implement improved/new workflows and share quality improvement curriculum, including best practices, clear expectations, and training and dissemination materials, for the eConsult initiative. This Team Member also works closely with Provider teams to implement eConsult workflows and integrate new processes into both primary care and specialty care clinics, coordinating with Provider Services, UM and IT staff at IEHP on related initiatives as needed to ensure clear, consistent, and achievable goals are set and met. The Provider Workflow Support Specialist will also support the Provider Relations Department with other duties as assigned.

Major Functions (Duties and Responsibilities)

 

1. Provide hands on support to Provider offices and clinics to implement and incorporate eConsult.
2. Providing support for current Providers and office staff with the eConsult system, assisting IEHP Team Members or Providers with issues and escalating to the appropriate Management.
3. Develop and manage strong relationships with Providers, responding quickly to inquiries and concerns and resolving them effectively, understanding Provider practices and utilization of eConsult.
4. Be a subject matter expert in the framework, workflow, and daily operations of the eConsult program, including system requirements, troubleshooting, reporting and data analytics.
5. Work closely with Provider Operations, Utilization Management and Provider Service Representatives to assist with any issue a Provider or office staff is experiencing with the eConsult process.
6. Document and archive all interactions with Providers and office staff and communicate trends to IEHP Management.
7. Engage facility teams to identify and implement process improvement and workflow redesign solutions to overcome challenges and achieve improvements in patient access to specialty care expertise through the eConsult Platform.
8. Conduct assessments of referral and scheduling workflows and processes, including standard work, template management policies, staffing structures, etc.
9. Provide guidance and develop supportive relationships to enhance facility engagement with eConsult and referral management.
10. Work closely with both internal and external eConsult team members to identify opportunities for improvement and follow through with clinic staff to implement additional training as needed.
11. Work closely with Provider teams to promote, advise on, and conduct in-service trainings, grand rounds, workshops, and other activities as needed to engage providers and staff in the eConsult initiative.
12. Communicate effectively as a liaison to Providers as they learn and master eConsult workflow.
13. Work with other WFEs to help with orientation, capture workflows, create documents and communicate with clinics and their staff.
14. Capture any meeting minutes with questions and or concerns that come up in the meetings.
15. Assist the PSRs by monitoring Providers through utilization reports, QA reports, Provider Report Cards, quality data and cases presented through IEHP’s Customer Relations Management Tool (HSP) to provide training to improve Provider performance, close care gaps and improve access to care.
16. Assist the PSRs by supporting the investigation and resolution of Provider grievances.
17. Promote electronic submission capabilities including the timely and complete submission of encounter data, claims and utilization data related to IEHP’s quality metrics, namely HEDIS.
18. Supports the Provider Relations Team with any activities that involve the improvement of outcomes with Providers and Members.
19. Develop and participate in training with all IEHP systems including HSP, Medhok and eConsult system.
20. Utilize Critical Thinking skills when working with internal and external stakeholders.
21. Embrace IEHP Mission, Vision and Values.

Supervisory Responsibilities

Leading: Self

Experience Qualifications

 

Two (2) years of experience in Provider office and referral and scheduling workflow and processes.

Preferred Experience

 

Customer service, sales and customer retention preferred. Two (2) years Healthcare or Health Plan Operations experience preferred.

Education Qualifications

 

Bachelor’s degree from an accredited institution required.

Preferred Education

Drivers License Required

Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement

 

Basic understanding of eConsult and referral management. Provider office and IEHP referral and scheduling workflow and processes.

Skills Requirement

 

Computer program aptitude including email, internet, and the Microsoft office suite (intermediate/advanced user). Excellent communication skills. Excellent time management skills.

Abilities Requirement

 

Ability to multi-task. Ability to perform conflict resolution. Ability to listen and demonstrate empathy when presented with Provider concerns. Aptitude to foster positive relationships. Problem solving attitude. Capable of moving in a fast-paced environment. Be able to work in multiple work environments at the same.

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

 

Travel outside regular business hours 

Work Model Location

Onsite

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Sitting - CONSTANTLY
Indoors - FREQUENTLY
Lighting - CONSTANTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

 

Starting Salary: $51,833.60  - $64,022.40  

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 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and 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 state pension plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles