Provider Relations Rep Job at CommonSpirit Health, Bakersfield, CA

L3FyVm1ML1dtWkZSY0VHWGpsSGNYdkczaEE9PQ==
  • CommonSpirit Health
  • Bakersfield, CA

Job Description

Overview:

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Healths Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Responsibilities:

As a Provider Relations Representative with the Dignity Health Management Services Organization (DHMSO), now part of CommonSpirit Health, you will enjoy the developing relationships as you provide process and system education and training to providers and clinic staff.

Your success in this role comes from your enthusiasm to help others, your innate ability to solve complex problems and desire for continuous growth and improvement.

Success in this role means you:

  • Have the ability to establish and maintain positive business relationships, negotiate favorably, collaborate with others, and build consensus both externally and internally to achieve desired results.
  • Understand Summary Plan Descriptions, Benefit Summaries, internal operations workflows, and claims policies & procedures.
  • Possess strong business acumen, customer service skills, follow-up, organizational and project management skills to ensure objectives and deadlines are consistently met.

  • Have the ability to understand and interpret regulatory concerns as applicable to the contract, including HIPAA privacy and security, CMS rules and regulations, and ERISA.
  • Are able to understand and articulate the processing of eligibility, authorizations and claims adjudication to the provider network
  • Are capable of continually re-prioritizing to meet the needs of internal and external customers throughout the workday. Possess a thorough knowledge of generally accepted professional office procedures and processes.
  • Enjoy and are able to work in the field 50% or more and also work independently via remote office.
  • Are able to travel to locations both in and out of town which may require overnight stays on occasion.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Qualifications:

Minimum Qualifications:

  • High School Diploma/GED - 5 or more years' experience working in a similar position in the healthcare industry; or an equivalent combination of training and experience that provide the capabilities needed to perform the job duties.
  • Experience in marketing, sales or customer service in a health care setting required. Strong business acumen, customer service skills, follow-up, organizational and project management skills to ensure objectives and deadlines are consistently met.
  • Familiarity with third party administrator operations such as eligibility, prior authorization, claims administration and provider network administration. Familiarity with managed care and self insurance products and benefits.
  • Prior experience demonstrating the ability to understand and interpret laws, rules and regulations as defined under state and Federal statutes along with remaining current on Healthcare Reform updates and changes.
  • Strong problem-solving abilities.
  • Ability to identify issues and problems within administrative processes, activities, and other relevant areas.
  • Excellent communication skills; able to read, write, and speak articulately, using established channels of communication and reporting relationships within the organization. Ability to communicate effectively with all levels of internal/external staff, management, clients, physicians and physician office staff.
  • Ability to handle various situations in a professional manner, demonstrating excellent customer service at all times and ability to adapt to change.
  • Ability to create professional documents using proper grammar, punctuation and appropriate reading level proficient in the use of Microsoft Office applications; Excel, Word, Access, Outlook, PowerPoint, Project.
  • Associate's degree or equivalent from accredited college or technical school; or two or more years of account management experience working with a medical group or IPA in a managed care environment.

Other Preferred Qualifications:

  • Experience working as an account manager in a direct to employer health plan preferred.

***The position is remote/work from home in the Bakersfield, Tulare, Fresno, Hanford, and Visalia areas.

CommonSpirit Health

Job Tags

Contract work, Local area, Remote job, Work from home, Flexible hours, Night shift,

Similar Jobs

Rossford Schools

ESL Teacher (Part-Time) Job at Rossford Schools

POSITION: District ESL Teacher QUALIFICATIONS: REQUIRED: Valid and appropriate Ohio Department of Education Licensure Excellent organization and communication skills Genuine desire to support efforts to achieve the district vison: Preparing, inspiring... 

Ads

Trabajo en proyectos de limpieza de casas Job at Ads

Trabajo en proyectos de limpieza de casas Category: Bienes racesCompaa de bienes y races requiere contratar personal o compaas para el servicio de limpieza de casas.Cargo Solicitado: Servicio de limpiezaPuestos Vacantes: 20Tipo de Contratacin: por proyecto... 

Jackson Hewitt - HUV

Client Support Associate Job at Jackson Hewitt - HUV

 ...enjoy building strong relationships with clients, then look no further and apply today! Join our team as a Seasonal Client Support Associate and be the friendly face for all those who visit our offices, ensuring exceptional client experiences and providing essential... 

Essen Health Care

Physician Assistant-All Specialties! Job at Essen Health Care

 ...offering specialties from womens health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services...  ...for you. Join our team today!Job Summary Job Summary: The Physician Assistant will support the doctors work and actively facilitate... 

Milton Hershey School

Houseparents - Relocation to Hershey, PA Required Job at Milton Hershey School

 ...backgrounds, creating a family-like environment. Couples work in on-campus homes, overseeing up to 12 students while managing daily responsibilities...  ...options; retirement savings Relocation assistance and paid training provided Schedule of nine days on followed by three...