POSITION SUMMARY: 100% IN VISTA, CA OFFICE

The primary functions will be to interface between the physician network, the IPA, and contracted health plans through ongoing education, training, and support activities. This individual will establish and maintain practice, provider, and member relationships through excellent customer service and rapport. Assisting, educating and outreach to providers on initiatives such as encounter data submission, AV program and Clinical Initiatives with the goal of optimizing practice performance is critical. This individual will collaborate with Risk Adjustment and Quality, Credentialing, Information Systems, Clinical Services, Compliance, and Claims department.

EDUCATION AND/OR EXPERIENCE:

• Bachelor’s degree in business, Healthcare Administration or related field of study; or, an equivalent combination of education and/or experience
• Minimum 5 years of experience in the healthcare industry; preferably with healthcare network operations
• Demonstrated understanding of risk and value-based contracting
• Proficiency with Microsoft Office suite and Internet/Intranet resources
• Strong provider relations skills and experience

HIGHLY PREFERRED SKILLS & QUALIFICATIONS:

• Extreme attention to detail and organizational skills
• Familiar with payment alternatives such as fee for service, capitation, and performance compensation.
• Familiar with patient and practice risk adjustment mechanics and premium-based payment methodologies
• Familiar with patient and practice risk adjustment mechanics, HCC/RAF
• Experience with database management in a healthcare setting
• Demonstrated ability to gain acceptance and compliance from provider and staff and achieve a mutually beneficial outcome
• Excellent problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

Excellent verbal, written and interpersonal communication skills

• Able to convey complex or technical information in a manner that others can understand, and able to understand and interpret complex information from others

• Assist providers with issues related to contracting, capitation, claims, referrals and eligibility. Will act as liaison between provider and applicable department.
• Serve as the primary point of contact and conduit between IPA and Physician’s Data Trust’s internal departments
• Establish and maintain provider rapport by conducting field visits to provider offices weekly
• Responsible for developing and strengthening relationships with various provider groups

• Responsible for the post-recruitment phase of the practice cycle to facilitate:
  o Onboarding
  o Training
  o Payer contract offerings
  o Strategic network communication
  o Performance reports and scorecards

  o Establish Cozeva and Aerial Care logins for providers and maintain records of logins provided

• Ensure the collection of contracting, credentialing, and updated information from participating practices/providers.

• Handle wrong lab claims for IPA including cap deduct warning letters and tracking
• Facilitate contracting, including drafting agreements, preparing Letters of Agreement and processing all agreements.
• Confidence in preparing and leading meetings as assigned
• Maintain PCP, Specialty and Ancillary rosters including health plan ID numbers *

Participate in marketing efforts to organically grow the IPA

• Process provider adds, changes and terminations using checklists to include configuration notification and health plan notification along with electronic file maintenance of contract. *
• Maintain provider manuals for PCP and Specialists including in-service materials.
• Provide oversight of practice contract implementation; identify opportunities for process improvement and facilitate issue resolution
• Guide members through challenges they may have with contracted groups and work to resolve network issues
• Perform other responsibilities as assigned for special projects and escalated issues
• Provider correspondence including newsletters, fax blasts and mass mailings. *
• Assist with annual member and provider surveys
• Complete audit tools for Health Plan audits upon request
• Assist with PCP meeting scheduling and preparation