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Job Description
Provider Relations Administrator
INNOVATIVE INTEGRATED HEALTH - 2.4
Fresno, CA Job Details Full-time $70,304 - $90,000 a year 1 hour ago Benefits Health savings account Health insurance Dental insurance 401(k) Flexible spending account Paid time off Employee assistance program Vision insurance Employee discount Life insurance Referral program Paid sick time Qualifications Working with seniors Driver's License Older adults Full Job Description Who We Are PACE by IIH is empowering senior participants to age at home with dignity through personalized, comprehensive care plans that deliver high-quality health and human services along with strong community support. Through an interdisciplinary and participant-centered model of care, PACE by IIH is committed to improving quality of life, promoting independence, and providing compassionate support tailored to the unique needs of each participant. Our team works collaboratively to deliver innovative, community-based healthcare solutions that allow seniors to remain safely and comfortably in their homes while receiving the care and services they need to thrive. Benefits 401(k) Dental insurance Employee assistance program Employee discount Flexible spending account Health insurance Health savings account Life insurance Paid sick time Paid time off Referral program Retirement plan Vision insurance Job Summary The Provider Relations Administrator is responsible for developing and maintaining relationships with Innovative Integrated Health's (IIH) Provider community which includes provider groups, physicians, hospital systems, skilled nursing facilities, home health, durable medical equipment and other organizational providers and administrators. The Provider Relations Administrator is the conduit for existing and new providers regarding contracts, reimbursement rates, referrals and credentialing. The Provider Relations Administrator is a community representative and will work on projects to enhance the provider network such that network adequacy in the specialties that are needed are developed. Essential Job Functions Duties include, but are not limited to: Serves as liaison with the provider community. Receives and responds to external provider related issues. Develop workflows, strategies, and special projects to meet provider network needs. Represents and promotes the knowledge of PACE to the Provider community in a professional and positive manner. Provider relations consist of several diverse provider contract administrative duties including direct provider engagement and training, regularly scheduled service visits with targeted providers, network capability monitoring, contract negotiations and resolution of provider issues. Responds to general provider contract inquiries. Responds to provider education needs and non-routine claim issues. May research, analyze and recommend resolution for provider disputes. Conduct provider outreach by conducting training and guidance to enable network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of the provider portal. Attend and participate in staff meetings, in-services, projects, and committees assigned. Adhere to and support the center's practices, procedures, and policies including assigned break times and attendance. Accept assigned duties in a cooperative manner; and perform all other related duties as assigned. Be flexible in schedule of hours worked. Travel to other Innovative Integrated Health may be necessary on occasion for coverage needs. May be required to use personal vehicle, if applicable. If using a personal vehicle, a valid California Driver's License is required. Knowledge, Skills and Abilities Proficient knowledge of computer skills. MS Office (Word, Excel, Access, PowerPoint, and Outlook). Knowledge of general office procedures, equipment and filing systems. Ability to communicate effectively, both orally and in writing. Ability to quickly learn department policies, procedures, goals, and services.
Skill:
Attention to detail and accuracy. Ability to change priorities regularly. Working Conditions and Physical Demands The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to access all areas of the center throughout the workday. Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance of another qualified employee when attempting to lift or transfer objects over 25 pounds. Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling. Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment. Experience Minimum of three (3) years of demonstrated experience in the healthcare field. Minimum of one (1) year of documented experience working with a frail or elderly population. Education A Bachelor's degree preferred. Core Values CARE is central to what we do, prioritizing the well-being, dignity, and independence of our senior participants.
COMPASSION
in every interaction, ensuring kindness, empathy, and understanding guide our care. CULTURE that reflects the diverse backgrounds of those we serve and fosters a workplace where every team member feels supported, valued, and empowered to grow.
COMMUNITY
that fosters connection, belonging, and support for participants and their families.
COMMITMENT
to quality improvement, innovation, and delivering healthier outcomes. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
