What are the responsibilities and job description for the Provider Advocate position at La Salle Medical Associates?
POSITION SUMMARY:
Under the direction of the Provider Services Director, the Provider Advocate is responsible for conducting on-site visits to Primary Care Physician (PCP), Specialty Care (SPC) and Ancillary Providers to ensure Providers have and are utilizing the appropriate tools to provide care to the patients under LaSalle Independent Physician Association (IPA).
The Provider Advocate is required to drive to meet and interact with Providers about 75% of the time. This position will primarily interact with Provider's in the Moreno Valley and Perris California region.
Provider Advocate will develop a relationship with Provider and Provider staff and be a support system when needing assistance with contracting questions, how to work with the Health Plans, claims assistance, utilization support and credentialing. Pursuant to these duties, the candidate should have some knowledge level in each of these areas. In addition, the Provider Advocate will train providers on the use of the portal and other tools to assist with patient eligibility, line of business, etc.
ESSENTIAL FUNCTIONS:
Maintain the PCP, SPC and Ancillary Network. This includes maintaining existing relationships and obtaining new ones.
Augmenting the Network of PCPs to grow new business.
Review areas of improvement for the SPC and Ancillary Network in order to maintain a strong network and be in compliance with Network adequacy standards from the health plans.
Generating contractual agreements and assisting in contract negotiations.
Able to explain Division of Financial Responsibilities to the Network.
Serving as a resource for Providers, internal staff and external partners to interpret and explain contract terms and conditions.
Able to comprehend and explain Federal and State Legislations to Provider Network.
Monitor, report and improve compliance with policy and services standards.
· Provides education and training to Provider Network and assist in completing attestations for the health plans.
Acts as a liaison between IPA, health plans and LaSalles’s Maintenance Service Organization (MSO).
Conducts claims audits and support Provider staff on areas of improvement.
Supply system trainings and reviews handouts, materials, and current health plan guidelines.
Support Providers when having claim challenges and become a liaison between Provider and MSO.
Assist Providers when needed on credentialing documentation to insure a smooth credentialing process.
Lead Joint Operation Meetings with Providers. Also, participate in Health Plan meetings.
Travel required throughout the region. Driver’s License and Proof of Insurance is required.
KNOWLEDGE, SKILLS AND ABILITIES (minimum qualifications):
- This position requires a HS Diploma or GED equivalent. Bachelor’s Degree preferred.
- Experience in a managed care environment with knowledge of credentialing, contract negotiations or understanding of contract language health plans, sales techniques are all highly desired.
- Ability to interpret agreements and understand compensation structures.
- Knowledge of Medi-Cal, MediCare and Commercial coverage.
- Great communication skills with staff, providers and patients.
- Exhibit flexibility when work assignments need to be adjusted.
- Outstanding organizational skills and able to multitask.
- Knowledgeable with MS Office, Excel, PowerPoint, etc.
- Commitment to Team culture
WORK ENVIRONMENT:
Preventative Care Advocate works in a clean clinical environment with ergonomically designed keyboards and counters. To prevent lifting strain injuries, use proper methods and ask for assistance if needed. Take regularly scheduled meal period and rest breaks.