Network Management Representative

This position is responsible for maintaining a working relationship with provider organizations as assigned. Acts as the liaison to providers and health plans, assesses provider-training needs, ensures compliance with contracts. Arranging for and conducting office manager meetings and physician meetings. Works collectively and individually to complete new provider orientation for all applicable product lines. Conducts face-to-face visits to service providers, resolve issues, educate staff/providers on policies, assist in collecting credentialing information, and review HEDIS information. Assess the changing needs of assigned network, identifies network gaps and collaborates with Contracting Department. 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, other vendors and health plans, as well as works special projects as assigned or directed.

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

• Dependable person with excellent written and verbal communication skills.
• 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 and other partners.
• Excellent interpersonal skills with the ability to meet and deal pleasantly and effectively with a variety of professionals at all levels within the organization as patients and community members.
• Analytical, interpersonal skills, and computer literacy
• Ability to perform tasks utilizing various office software (Excel, PowerPoint, Microsoft Word and Visio) 

Required Experience

Required:

• The Provider Network Representative should have at least three to four years’ experience in provider relations field with a managed care organization, IPA, or HMO.
• Good knowledge of healthcare and insurance industry (HMO/PPO/MA/MAPD). 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.

Preferred:

• A bachelor’s degree in business administration, Healthcare Management, Organizational Development, or another related field is preferred. Department Management to list.