The Network Management Representative is responsible for recruiting new provider organizations and maintaining a working relationship with current provider organizations as assigned. Assists in identifying prospect provider organizations, arranging introductory meetings, and leading onboarding activities with required departments to meet the network capacity needs of PIH Health. Acts as the liaison to providers and health plans, assesses provider-training needs, ensures compliance with contracts and participation in Quality and Risk Adjustment programs. Arranging and conducting office manager meetings and physician meetings. Works collectively and individually to complete new provider orientation for all applicable product lines. Manages a portfolio of assigned provider organizations throughout the entire customer lifecycle. Conducts face-to-face visits to service providers, resolve issues with health plans and PIH Health, educate staff/providers on policies and programs, assist in collecting credentialing information, and review Quality, Risk Adjustment, and other performance information. Organizes and manages provider network meetings between IPA provdiers and PIH Health and MSO. Assess the changing needs of assigned network, identifies network gaps and collaborates with appropriate PIH Health departments. Provides oversight on escalated inquiries and claim issues and follows up with providers to ensure problems have been resolved, strategizes for membership growth and retention, work closely with brokers, vendors and health plans, as well as works special projects as assigned or directed. Frequent traveling to offices across PIH Health’s service area. Reliable transporation is required.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Ability to communicate technical issues to non-technical audiences, including physicians, physician’s staff, etc.
• Ability to analyze data to identify trends, and variance from goals. Working knowledge of medical terminology, claims payment and problem resolution is required.
• Good knowledge of healthcare and insurance industry (HMO/PPO/MA/MAPD) and medical groups/IPA
• Excellent interpersonal skills with the ability to interact and work effectively with internal and external department, community and other audiences.
• Must possess ability to organize, plan daily activities and demonstrate initiative with minimal supervision and to complete projects under pressure of deadlines.
• Must be able to handle numerous tasks simultaneously and work with colleagues to execute projects, events.
• Must develop and maintain relationships with provider network, vendors, health plans, and other partners.
• Analytical, interpersonal skills, and computer literacy
• Working knowledge of prior authorization processes, medical claims processes, CMS Quality and Risk Adjustment programs
• Ability to perform tasks utilizing various office software (Excel, PowerPoint, Microsoft Word and Visio)

Required Experience

Required:

• A bachelor’s degree in Business Administration, Healthcare Management, Organizational Development, or another related field, or at least three to four years’ relevant experience in provider relations with a managed care organization, IPA, or HMO.

Preferred:

• A master’s degree in Business Administration, Healthcare Management, Organizational Development, or another related field.

• Ability to communicate technical issues to non-technical audiences, including physicians, physician’s staff, etc.
• Ability to analyze data to identify trends, and variance from goals. Working knowledge of medical terminology, claims payment and problem resolution is required.
• Good knowledge of healthcare and insurance industry (HMO/PPO/MA/MAPD) and medical groups/IPA
• Excellent interpersonal skills with the ability to interact and work effectively with internal and external department, community and other audiences.
• Must possess ability to organize, plan daily activities and demonstrate initiative with minimal supervision and to complete projects under pressure of deadlines.
• Must be able to handle numerous tasks simultaneously and work with colleagues to execute projects, events.
• Must develop and maintain relationships with provider network, vendors, health plans, and other partners.
• Analytical, interpersonal skills, and computer literacy
• Working knowledge of prior authorization processes, medical claims processes, CMS Quality and Risk Adjustment programs
• Ability to perform tasks utilizing various office software (Excel, PowerPoint, Microsoft Word and Visio)