GET SIMILAR JOBS BY EMAIL.
Sign Up
Job Summary
- Company
- NAMM California
- Location
- Redlands/Moreno Valley/Hemet, CA 92373
- Industries
- Healthcare Services
- Job Type
- Full Time
- Employee
- Years of Experience
- 2+ to 5 Years
- Education Level
- Bachelor's Degree
- Career Level
- Experienced (Non-Manager)
Provider Service Representative
About the Job
NAMM California, a leader in the managed care industry, has an immediate opening for a Provider Service Representative in the Redlands/Moreno Valley/Hemet area.
RESPONSIBILITIES:
Directly responsible for working with IPA physicians to ensure provider satisfaction in accordance with the IPA standards
Directly responsible for working with the designated health plan representatives on local issues and concerns (including directory accuracy)
Directly responsible for all physician education including distribution of key IPA documentation and policies and procedures and orientations
Directly responsible for education of physician's management staff and performs regularly scheduled Office Manager's meetings
Responsible for ensuring network compliance with regulatory requirements including but not limited to accessibility and availability of required specialties
Responsible for understanding local market dynamics performing routine market analysis and organizing appropriate marketing and promotional activities
Responsible for ensuring network is maximized based on market analysis and that there is no network gaps, including identification of new providers
Responsible for optimizing electronic connectivity between the providers and NAMM operations to ensure economical transaction management
Manage provider contracts deemed appropriate by the Executive Director
SKILLS REQUIRED:
Bachelors degree in communication-related field or equivalent experience
5-7 years health care marketing/provider.
Computer literate in word and excel. Access and power point experience preferred.
Ability to effectively present information and respond to questions from physicians, clients, customers and the general public
Strong organizational and communication skills. Adept at problem solving
Working knowledge of ICD-9, CPT and HCPCS coding
Able to construct and interpret contract language/terms
Bilingual (English/Spanish) highly desirable
BENEFITS:
Competitive compensation and benefits such as medical, dental, vision, life and AD&D insurance, short and long term disability, 401(k), educational reimbursement, and more!
RESPONSIBILITIES:
Directly responsible for working with IPA physicians to ensure provider satisfaction in accordance with the IPA standards
Directly responsible for working with the designated health plan representatives on local issues and concerns (including directory accuracy)
Directly responsible for all physician education including distribution of key IPA documentation and policies and procedures and orientations
Directly responsible for education of physician's management staff and performs regularly scheduled Office Manager's meetings
Responsible for ensuring network compliance with regulatory requirements including but not limited to accessibility and availability of required specialties
Responsible for understanding local market dynamics performing routine market analysis and organizing appropriate marketing and promotional activities
Responsible for ensuring network is maximized based on market analysis and that there is no network gaps, including identification of new providers
Responsible for optimizing electronic connectivity between the providers and NAMM operations to ensure economical transaction management
Manage provider contracts deemed appropriate by the Executive Director
SKILLS REQUIRED:
Bachelors degree in communication-related field or equivalent experience
5-7 years health care marketing/provider.
Computer literate in word and excel. Access and power point experience preferred.
Ability to effectively present information and respond to questions from physicians, clients, customers and the general public
Strong organizational and communication skills. Adept at problem solving
Working knowledge of ICD-9, CPT and HCPCS coding
Able to construct and interpret contract language/terms
Bilingual (English/Spanish) highly desirable
BENEFITS:
Competitive compensation and benefits such as medical, dental, vision, life and AD&D insurance, short and long term disability, 401(k), educational reimbursement, and more!
