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. Health maintenance organization provider relations, recruiting and credentialing requirements and procedures; managed care contracting methods; medical reimbursement methodologies. Communicate effectively, both verbally and in writing; adapt to a rapidly evolving work environment; work independently and manage multi-task responsibilities; intervene in crisis situations on behalf of the health Plan or providers; deal with difficult people, prioritize workload, make decisions, resolve provider relations concerns; prepare and organize reports and surveys regarding provider relations activities and statistics; effectively use various computer programs. Required travel up to 40%. Possession of valid California Driver’s License and proof of valid State required auto liability insurance.
We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits. As a condition of employment, a satisfactory drug test and background check are required. E.O.E.