Provide Services Representative

KORE1, a nationwide provider of creative and information technology recruiting, has an immediate opening for a Contract Medical Provider Services Representative for a large healthcare organization in Ontario. This is a great opportunity to make an impact directly with providers on a regular basis. The role entails regular communication of organizational policies, procedures and processes, and to help anticipate and respond to Provider educational needs. Core duties and wanted skills and experience are as follows:

Core Duties

• Perform new Provider orientations, continuous training and education to office staff and Providers. Maintain accurate and timely log of Provider visits to ensure compliance with NCQA standards, and DHCS and CMS regulatory requirements
• Act as liaison between providers and our client's departments to help resolve provider, member and IPA concerns
• Monitor and support Providers via our clients' utilization reports, provider report cards, quality data and cases presented via our client's CRM system
• Investigate Provider grievances
• Communicate with IPA staff regarding Provider issues, quality initiatives and Provider changes and help resolve Member and Provider cases
• Assist Providers with interpreting our client's eligibility, capitation, claims and quality reports
• Liaise with Contract Department to address provider inquiries concerning rate/service changes and claims disputes
• Visit Primary Care Physicians, Specialists, BHS's and Vision providers on a somewhat regular basis
• Review provider Directory and ensure contact information is updated regularly
• Ad hoc duties as needed

Wanted Skills/Experience

• California Driver's license and high school diploma
• 3+ years of experience with managed care with a working knowledge of Medical Group, IPA and HMO operations
• Extensive customer service experience
• Well versed in all aspects of Microsoft Office (Word, Excel and Access)
• Excellent written and verbal communication skills

Qualifications

• California Driver's license and high school diploma
• 3+ years of experience with managed care with a working knowledge of Medical Group, IPA and HMO operations
• Extensive customer service experience
• Well versed in all aspects of Microsoft Office (Word, Excel and Access)
• Excellent written and verbal communication skills

Additional Information

we require candidates having good experience in health care industry and customer service and working knowledge of IPA and HMO operations