Provider Support Coordinator in Orange, California at Astiva Health

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

Summary:

The Provider Support Coordinator is responsible for providing the highest level of service to IPA’s, Medical Groups, MSO’s, providers, hospitals, and ancillary providers (Network Providers). The PSC is responsible for participating in the recommendation, development and implementation of Quality-of-Service strategies which improves operations and provider satisfaction.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

• Establishes and maintains positive working relationships with contracted providers.
• Responds timely to provider calls/voicemails and emails. Works with internal departments to resolve and close the issues related to, eligibility and benefits, contracting, claims, and referrals.
• Confirms provider information by phone calls to ensure correct provider directory as required.
• Processes provider adds, changes and terminations requests from Medical Groups/IPA daily. Communicate and validate provider demographics to comply with the Health Plans SB137 regulations as needed.
• Assists with provider portal account for contracted providers.
• Provides virtual portal training to contracted providers.
• Assists the Credentialing department by following up with providers to collect pertinent documents as needed.
• Coordinates with the Sale/Marketing Department to organize and participate in marketing events as needed.
• Schedules and coordinates meetings with providers for education purposes and initiatives such as annual wellness exam.
• Regular and consistent attendance
• Other duties may be assigned as needed.

BENEFITS:

• 401(k)
• Free catered lunches
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off

EDUCATION and/or EXPERIENCE:

• High School diploma or GED required
• Bachelor’s degree in Healthcare Administration, Finance, Business Administration or related field or a combination of education and experience
• 1 year previous experience in a provider relations role within a health plan, IPA, or medical group strongly desired.
• Strong working knowledge of Medicare, Medicaid and HMO health plan required.
• Stellar critical thinking with the ability to independently research complex issues.

LANGUAGE: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups and customers or employees of the organization.

MATHEMATICS: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

EEO/AFFIRMATIVE ACTION STATEMENT: It is the policy of Astiva Health to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. This policy relates to all phases of employment, including but not limited to recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company sponsored employee activities. Provisions in applicable laws providing for bona fide occupational qualifications, business necessity or age limitations will be adhered to by the organization where appropriate. Please refer to Standard Operating Procedure 100 for more information about the organization’s Affirmative Action/EEO statement.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit and complete work while on a computer. The employee occasionally is required to stand, walk, use hands to finger, handle or feel, reach with hands and arms, stoop, kneel, crouch or crawl, climb or balance, talk and hear.

While performing the duties of this job, the employee is occasionally required to lift or exert force up to 10 pounds.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.