Description: Under general direction of the department supervisor, the Provider Relations Representative is responsible for assigned duties and activities in the Provider Relations Department to ensure an appropriate network of health care providers is available to the members of Kern Health Systems (KHS). This position is responsible for the assigned duties in the provider relations functions for a Knox-Keene licensed health care maintenance organization which includes daily contact with network providers to establish and maintain relationships beneficial to the Plan, the Providers and the Members.
Requirements: High School Diploma from an accredited school or equivalent and completion of 60 semester units or 90-quarter units from an accredited college or university. (Industry related training may be accepted as substitution.) Three (3) years provider relations or medical staff experience preferred. (Two (2) years of related managed care experience may be substituted for each year required.) Relational database experience, windows environment preferred. Knowledge of Health maintenance organization provider relations, recruiting and credentialing requirements and procedures. Managed care contracting methods, medical reimbursement methodologies. Required travel up to 40%. Valid California Driver License and proof of valid State required auto liability insurance.