Provider Relations Coordinator

KHS reasonably expects to pay starting compensation for the position of Provider Relations Coordinator I in the range of $23.27 - 29.09 hourly.

Hybrid

Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Under direction of the Department Director or Supervisor, performs a variety of administrative support functions needed to complete all the tasks necessary to maintain the Core Provider Database and the Provider Documentation Database while performing other Provider Relations duties. Completes entries of necessary data collection and tracking, completes all tracking forms received from the Provider Relations Representatives in the Provider Documentation Database, collaborates with Provider Relations and other departments, provides clerical support as needed, and provides oversight and contract tracking functions.

Assists with special projects and ensures target outcomes are achieved within assigned deadlines. The Kern Health Systems (KHS) Provider Relations Coordinator is responsible for assisting the Director, Supervisor, and department with their day-to-day task by supporting them in a variety of clerical and data entry activities for a Knox-Keene licensed Health Maintenance Organization (HMO). Positions requires a high level of accuracy and excellent decision-making and organizational skills.

• Composes letters, memos, confidential reports, and completes standard forms from information received in handwritten or typed form, generally without being given specific oral or written instruction.
• Assists in the completion of departmental compliance reporting
• Enters all provider updates received from the Provider Relations Representatives in the Provider Documentation Database to ensure all systems within Provider Network Management are updated.
• Provides phone coverage for the Provider Relations Representatives that are in the field including answering all questions, documenting in the Provider Documentation Database, and communicating with the assigned Provider Relations Representative.
• Assists Provider Relations Representatives with provider outreach to include returned mail and W-9 requests.
• Responsible for regular data entry quality reviews.
• Effectively communicates with other KHS Departments regarding provider set-ups, claims and reporting.
• Maintains data integrity in Provider Documentation Database.
• Able to work directly with Core Provider Database to understand system functionality and the processing of data transaction for business functions such as provider set up, eligibility, claims and authorizations.
• Able to work directly with the Provider Documentation Database, including adding new vendors and providers as well as updating the system to reflect any changes.
• Able to assist Provider Relations Representatives with the retrieval of both HEIDIS records for the annual DHCS audit.
• Creates manual and electronic files. searches for files. retrieves information from files. monitors use of confidential and miscellaneous files and their contents. purges files and/or information from files. closes files.
• Sets up or revises filing systems. sorts and files a variety of printed and/or recorded materials.
• Operates a variety of office machines such as, copier, facsimile, and multiple line telephone systems.
• Operates proficiently in various commercial software systems, and specialized department systems to accomplish data input, manipulation and output.
• Prepares a variety of departmental forms for approval as needed per company policy.
• Responsible for weekly, monthly, and quarterly reports as assigned.
• Assists in the development, organization and coordination of internal and external meetings.
• Reviews logs and updates computer system with departmental related information.
• Proofreads departmental communications.
• Acts as departmental liaison.
• Basic awareness of the influence that data, created or used, by the Provider Relations department has on overall Health Plan operations with the ability to documents or investigate issues as to why a certain behavior or outcome is exhibited through department’s data metrics.
• Assists management staff and other departments in completing special projects, as assigned.
• Performs other job-related duties as required.
• Adheres to all company policies and procedures relative to employment and job responsibilities.
• Maintains Departmental Inventory including promotional items for the provider network.
• Assist with the planning and set up for quarterly Provider Forums.
• Provides administrative support to department.
• Assists in generating and compiling statistical data as requested such as creation of Excel Worksheets detailing contract status and provider specific profiles on a daily basis.
• Various filing and administrative duties and all other duties as assigned.
• Strong attention to detail. work accurately and at a reasonable rate of speed.