Rate:

$50kto $65k per year

Clinica Medica General(CMG), a Nexus HR Company, is looking for a

Provider Relations Representative

Duties and Responsibilities:

The Provider Relations Representative will work as the main point of contact for our providers and provider network. As a Provider Relations Representative, you will need to investigate and resolve provider issues while helping to expand knowledge of our services. In this position, the PR rep is also responsible for answering questions from health care providers about service contracts, in-network services available, and billing.

• Educates providers on protocols, policies, procedures, portals, and services to improve overall provider experience
• Maintain a positive, professional, and amenable relationship with the provider network
• Escalates issues as appropriate
• Serve as primary contact for providers and serving as a liaison between the provider and the IPA
• Receive and respond to external provider related issues
• Resolve, investigate and communicate provider claim issues and changes
• Initiate entry or change of provider related database information
• Author change requests and oversee through testing and completion
• Conduct regular meetings and check-ins with providers documenting discussions, issues, attendees, and action items
• Research claims issues on-site and routing to the appropriate party for resolution
• Other relevant tasks, as assigned

Qualifications:

• 3 years of experience in Provider Relations or comparable work experience
• Bachelor’s degree in Healthcare related field preferred*
• Strong verbal and written communication and interpersonal skills
• Located or willing to relocate to Los Angeles, CA
• Knowledge of health care, managed care, Medicaid or Medicare
• Experience with Customer Relationship Management tools
• Bilingual (English/Spanish) is highly preferred