Provider Services Representative I
Company: Gold Coast Health Plan
Location: Camarillo
Posted on: May 16, 2022
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Job Description:
Job DescriptionPOSITION SUMMARYThe Provider Network Operations
Representative I, is a member of a cohesive unit that responds to
and provides education to providers regarding Gold Coast Health
Plan and its health care programs. The Provider Network Operations
Representative I will directly represent Gold Coast Health Plan and
will focus on maintaining a positive presence in the community.
This position includes performing all activities related to
provider data base management and internal provider relations
functions for the Provider Relations Department. Ensure accuracy
and timeliness of data entry of provider network data into the
Provider Relations department software. Assist with all provider
data management including contracted and non-contracted provider
data and other software programs by GCHPESSENTIAL
FUNCTIONSReasonable Accommodations StatementTo accomplish this job
successfully, an individual must be able to perform, with or
without reasonable accommodation, each essential function
satisfactorily. Reasonable accommodations may be made to help
enable qualified individuals with disabilities to perform the
essential functions.Essential Functions Statement(s)• Assist with
the maintenance of all provider data• Assist Management with the
network development team activities to produce timely and positive
results• Provide timely handling and completion of assigned
projects.• Provide regular and timely reports for all assigned
projects. • Improve the efficiency of the Network Operation process
and procedures to enhance quality and efficiency• Be able to
respond to claims submission questions and have a good
understanding of provider claims submissions• Provide timely and
accurate submission al of all company requested projects,
assignments and reports• Act as a liaison between GCHP provider
community to effectively resolve provider issues and concerns•
Communicate with telephonically with providers and their staffs to
obtain and provide follow up information• Provider face to face
provider education• Be Familiar with regulatory requirements around
provider data reporting and apply to project workload• Be familiar
with Gold Coast Health Plan's contract requirements for PCPs and
Specialists.• Work with providers to adhere to contract and
regulatory requirements• Data entry, audit, daily maintenance of
the PR department master data• Research, review and make updates to
user requests within provider data management system• Review
provider setup and ensure all records are accurate Update provider
and practitioners, facilities (Hospitals and Clinics) status to par
by adding claims payment information• Maintain additional provider
data reports as needed for Ad Hoc reporting• Participate on
internal workgroups related to Provider data management and/or new
program implementation• Participate in special projects or
reporting as directed by Manager/Director• Perform Provider
telephone inquiries around provider data• Develop and maintain data
system procedures• Assist with GEO Access data management and
reporting• Back up to Compliance/Provider Database Coordinator•
Keep Manager and Director informed and updated on all issues and
activities• Provider Relations department liaison with other
internal departments• Participate in Ad Hoc workgroups as directed
by Manager• Projects assigned by the management that involve the
Provider Relations/Network Operations Department.• Other duties as
assigned by management.POSITION QUALIFICATIONS Competency
Statement(s)• Management Skills - Ability to organize and direct
oneself and effectively supervise others.• Initiative - Ability to
make decisions or take actions to solve a problem or reach a goal.•
Customer Oriented - Ability to take care of the customers' needs
while following company procedures.• Diversity Oriented - Ability
to work effectively with people regardless of their age, gender,
race, ethnicity, religion, or job type.• Interpersonal - Ability to
get along well with a variety of personalities and individuals.•
Time Management - Ability to utilize the available time to organize
and complete work within given deadlines.SKILLS &
ABILITIESEducation: High School diploma, Associate Degree or
certification in Healthcare processes a plus. Minimum 3 (three)
years healthcare experience. Must have previous experience with
provider data, knowledge of medical terminology and medical
provider/practitioner terminology. Project management a plus.
Experience: Minimum 3 plus years of experience in the health care
field interacting directly with providers.Computer Skills: Advanced
computer skills included in the MS Office products. Certifications
& Licenses: A valid California Driver's License and insuranceOther
Requirements:
Keywords: Gold Coast Health Plan, Camarillo , Provider Services Representative I, Sales , Camarillo, California
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