Provider Relations Advocate

San Bernardino, CA 92411

Post Date: 05/22/2018 Job ID: 42161 Profession: Medical Management

Passionate about kids and healthy living? Looking for a group that practices prevention and progressive treatment? This is the group for you! Large IPA with nearly 5,000 Primary Care and Specialty Providers is looking for a Provider Relations Advocate to support this network. Benefits are OUTSTANDING!! Numerous opportunities available for community involvement and giving back to those in need!

Provider Relations Advocate will be responsible for:

Managing network of Primary Care and Specialty Providers

Contributing to the growth of the current network

Communicate with all Providers and act as liaison between IPA and Providers

Support Providers and their office staff with information pertaining to HEDIS and IPA policies and guidelines

Educated staff and ensure State and Federal compliance guidelines are met

Maintain relationship with Physicians, health plan representatives, and clinic and hospital staff

Visit with Providers and report back on status of visits

Maintain knowledge of authorizations, claims, eligibility, and compliance standards in order to educate and answer inquiries from Providers and health plans

Schedule monthly meetings with partners

Document all Provider Network functions such as status changes, member transfers, provider termination, and more

Review IPA s network Physicians and Clinics in each geographic division to ensure all areas have proper coverage

Participate in meetings

Handle all member and provider concerns

Must have:

4+ years of Provider Relations or Provider Network experience

Bachelor s Degree

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