PROVIDER RELATIONS REP II in Cypress, CA at Beacon Health Options

Date Posted: 9/6/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Provider Relations Representative II to join our team at our office in Cypress, CA. Under the general supervision of the Director of Provider Relations: coordinates, develops and processes a multitude of reports related to the provider network. Routinely interfaces with existing providers and providers’ office staff to develop a solid business relationship. Assist Director in conducting provider meetings, education and training classes, as well as, any special projects.  Establish timely action plans and guidelines to maintain and service new and current providers, assist with network development, investigate non-standard requests and problems, and provide explanations and information to others on topics within area of expertise for Beacon’s Cypress, CA service center.  

Position Responsibilities:

Commercial Contract

  1. Answering provider questions about Beacon, its contracts, policies and procedures
  2. Maintain a collaborative relationship with the operations, business personnel and provider community to incorporate process-related information into the training curriculum.
  3. Remain current on regulatory and company policy that impacts the provider network and related issues.
  4. Solid technical writing skills with a demonstrable ability to translate technical jargon and information into business-friendly language.
  5. Manage multiple, simultaneous, and complex projects.
  6. Engaging providers in Beacon’s quality improvement activities.
  7. Acting as a resource for providers on an ongoing basis to answer questions and resolved issues as they arise and act as a liaison between providers and other Beacon departments.
  8. Negotiate fee for service rate changes and contract terms with network providers.
  9. Identifying and soliciting providers based on network need for new and existing business.
  10. Securing completed contracts and credentialing materials from providers who have been invited to join the network.
  11. Provide general support to all Network development activities.
  12. Strategize with members of the management team to ensure access and availability of providers meets current standards.
  13. Collaborate with other departments to address and resolve operational issues as related to negotiated contract language.
  14. Prepare reports and analyze data as directed by the Director of Provider Relations or other members of the management team.
  15. Adhere to all Beacon policies and procedures and standards of operations.
  16. Completes all required and assigned trainings.
  17. Attend all mandatory company or department meetings.
  18. Report to each scheduled shift and commence work and perform essential job function at the start of each

Government Contract

  1. Answering provider questions about Beacon, its contracts, policies and procedures
  2. Creates and manages training curriculum related to subject matter including provider relations staff trainings, provider orientations and ongoing provider support.
  3. Plan and facilitate trainings using various technology solutions, including new applications and procedures.
  4. Maintain a collaborative relationship with the operations, business personnel and provider community to incorporate process-related information into the training curriculum.
  5. Remain current on regulatory and company policy that impacts the provider network and related issues.
  6. Solid technical writing skills with a demonstrable ability to translate technical jargon and information into business-friendly language.
  7. Lead classroom-style training sessions remotely, in-person and via WebEx/video conference.
  8. Manage multiple, simultaneous, and complex projects.
  9. Engaging providers in Beacon’s quality improvement activities.
  10. Acting as a resource for providers on an ongoing basis to answer questions and resolved issues as they arise and act as a liaison between providers and other Beacon departments.
  11. Conduct provider site visits and other audits to ensure provider compliance with Beacon policies and NCQA accreditation standards.
  12. Strategize with members of the management team to ensure access and availability of providers meets current standards.
  13. Prepare reports and analyze data as directed by the Manager of Provider Relations or other members of the management team.
  14. Adhere to all Beacon policies and procedures and standards of operations.
  15. Completes all required and assigned trainings.
  16. Attend all mandatory company or department meetings.
  17. Report to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.
  18. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  19. Performs special projects and other duties as assigned and required.

Position Requirements:

Education: Education or Equivalent Experience: BA/BS degree preferred

Licensure:  Valid CA driver’s license and a clear DMV record.

Relevant Work Experience:   Minimum 2 years’ experience in the HealthCare field.

Knowledge, Skills & Abilities:

  • Customer Service experience required; provider relations experience required.

  • Very strong verbal and written communication skills.

  • Must be detail oriented and able to work independently in a fast changing environment.

  • Strong understanding of managed care and health care operations.Behavioral health experience preferred.

  • Must be able to work collaboratively with internal staff and external providers.

  • Must be well organized. Requires excellent communication and writing skills.

  • Have a professional demeanor and good public relations abilities.

  • Advanced level of PC skills required in Word and Excel. 

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

#CB

PM16