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Provider Relations Liaison
COSTA MESA CA 92627
Category: Pharmacist, Health Care Industry
  • Your pay will be discussed at your interview

Job code: lhw-e0-88629901

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Summary

  Job posted:   Sun Apr 22, 2018
  Distance to work:   ? miles
       
  1 Views, 0 Applications  
 
Provider Relations Liaison
OVERVIEW OF THE POSITION:

Responsible for the operations of the provider network(s) in assigned region, and is the direct interface between HealthCare Partners (HCP) and the affiliate physician network. This position provides continuous education, support, training and troubleshooting to physicians and their staff. Serve as an interface between the central departments and the Independent Physician Association (IPA) network.




ESSENTIAL FUNCTIONS:



Service excellence:



+ Serves as single-point-of-contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract reimbursement, practice and network profitability, ACOs and other HCP initiatives, as applicable.


+ Responds timely (within one business day) to provider issues, works with other groups/central departments to resolve issues and updates providers and office staff regularly through to resolution.


+ Is proactive in identifying issues and determining root cause so that they can be resolved timely and completely. Escalates certain issues as appropriate to leadership.


+ Build collaborative relationships with IPA physicians and their office staff.





Presence & Visibility:



+ Adheres to scheduled cadence for touchpoints and ensures that agreed upon agenda is followed and action items are documented and tracked.


+ Attends external office staff meetings and community/town hall meetings, as required, and completes any action items that may arise from those meetings.


+ Maintains awareness of providers interested in further engaging with HCP on new business opportunities (contracts and business combinations), and on shifting market/competitive dynamics that would impact the IPA.





Provider Training and Adherence



+ Onboard new physicians and their office staff.


+ Works with office staff to develop and maintain adherence to HCP processes.


+ Be available to answer questions and train staff on various portals and other resources available.


+ Educates physicians on incentive programs and the potential earnings.


+ Ensures that the physicians and their office staff receives and understands the various communications that are issued. Evaluates training needs for physicians and offices, and ensures the timely delivery of needed training.





Clinical Quality and Patient Satisfaction:



+ Regularly educates offices on their current performance on key performance indicators (KPIs).


+ Monitors performance of assigned PCPs, identifies low performing PCPs and works with IPA leadership to develop action plan for specific metrics needing improvement. Works with office to effectuate action plan and monitors progress. Intervenes and escalate issues as appropriate.


+ Engages, seeks assistance and intervention from IPA Medical Director and/or Quality Manager.


+ Knowledgeable about the various quality measures and improvement programs, and educates the offices on how to improve performance.


+ Supports and helps practices to earn the maximum bonus possible related to Clinical Quality and Patient Satisfaction measures.


+ Engages IPA physicians and staff in enhancing quality and patient satisfaction.





Growth and Retention:



+ Works collaboratively with offices, HCP marketing team and brokers to drive membership growth and retention.


+ Monitors and identifies trends on membership decline and escalates to leadership as appropriate.


+ Addresses PCP specific issues identified as part of dis-enrolled member calls.


+ Assists with OEP efforts by working with offices, marketing team, and brokers; attends OEP events with marketing to strengthen relationships with PCPs.




General citizenship:



+ Collaborates with leadership on special projects and strategic initiatives.


+ Represents HCP at community and other provider meetings.


+ Scrupulously adheres to PHI and HIPAA standards.


+ Performs additional duties as assigned.





EDUCATION:



+ Bachelor's degree preferred.





EXPERIENCE:



+ Prior experience in a health plan, managed care organization, medical group physician office or IPA setting preferred.


+ Customer service experience.





KNOWLEDGE, SKILLS, ABILITIES:



+ Excellent verbal and written communication skills.


+ Strong customer service and interpersonal skills.


+ A team player with strong listening skills.


+ Ownership mindset for assigned network of physicians and practices.


+ Positive, roll up your sleeve attitude.


+ Able to work with all levels of personnel (e.g. from MD to office staff).


+ Takes initiative and is proactive.


+ Detail Oriented with strong problem solving skills.


+ Good understanding of HMO systems' provider reimbursement mechanisms.


+ CPT-4 and ICD-10 coding systems.


+ Excellent computer skills.


+ Expertise in Microsoft Office applications (Word, Excel, PowerPoint).


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