Provider Services Representative II

The expected pay range is based on many factors such as geography, experience, education, and the market.
The range is subject to change.
This is a hybrid position.
What You Will Be Doing: Under general supervision, responsible for establishing and maintaining provider relationships, and ensuring the efficient and effective operation and administration of provider contracts.
The PSR II spends the majority of time in the field as directed by Director or V.
P.
Monitors, researches and addresses provider and administrative issues operational issues, outcomes and trends; prepares and submits findings and recommendations.
Establishes and maintains provider relationships; plans and facilitates regular meetings and communications with providers and stakeholders to provide information and training, address service and administrative issues, implement plan changes, and other items as directed.
Plans and facilitates regular meetings and communications with assigned providers to provide information and training, address service and administrative issues, implement plan changes, and others as necessary.
Assists in network development activities, including engaging in recruiting efforts with identified providers and identifying contract opportunities.
Monitors provider and HPSJ compliance with contractual terms; makes recommendations based on findings.
Documents requested contract changes, provider grievances, provider demographic changes, and claims, financial and other issues; forwards to appropriate departments to be addressed.
Develops materials and other documents in collaboration with stakeholders; distributes and communicates to providers in a timely and effective manner.
Collaborates with internal and external stakeholders to ensure the integrity, validity and timeliness of documents and data.
Creates, maintains and publishes periodic and ad hoc reports and arranges for distribution; reviews and validates provider related reports.
Provides training to new employees based on established guidelines; provides coaching and training based on established standards.
Assists in the development of job aids, workflows, procedures and other documents as directed; implements in a timely and effective manner; makes recommendations for revisions.
Travel to various providers within the service area required.
(Travel days will vary) Our Vision: Continuously improve the health of our community.
Our Mission: We provide healthcare value and advance wellness through community partnerships.
What You Bring: Knowledge, Skills, Abilities and Competencies Required Produces work that is accurate and complete.
Produces the appropriate amount of work.
Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
Rebounds from setbacks and adversity when facing difficult situations.
Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
Strong understanding of the importance of the relationships between providers and HPSJ.
Basic knowledge of network development and management strategies.
In-depth knowledge and understanding of the issues affecting providers in HPSJ’s service areas.
Basic knowledge of regulatory guidelines related to commercial, Medi-Cal/Medicaid and managed care contracting.
In-depth knowledge of provider and/or facility contract and payment structures, and reimbursement practices, including capitation.
Basic knowledge of medical terminology and coding.
Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
Basic leadership skills, including but not limited to the ability to influence without authority and motivate others.
Commitment to and ability to facilitate the adoption of HPSJ’s strategy, vision, mission and values.
Strong oral and written communication skills, including the ability to communicate professionally and persuasively, and effectively explain complex information.
Strong presentation skills, including but not limited to the ability to tailor presentations to a specific audience, and identify key messages.
Strong listening skills, with the ability to accurately receive and understand messages.
Basic conflict resolution skills, including the ability to use tact and diplomacy to diffuse emotional situations.
Time management and organizational skills.
Uses time effectively and efficiently.
Values time.
Concentrates his/her efforts on the more important priorities.
Can attend to a broader range of activities.
Meets deadlines.
Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and information.
Strong skills in Word, Excel, Windows, Outlook and PowerPoint.
Basic mathematics skills.
Ability to work independently and as part of a team.
Ability to treat confidential information with appropriate discretion.
Ability to speak and be understood in English.
Preferred Knowledge of and ability to use report generation software such as Business Objects and/or SQL Server Reporting Service (SSRS).
What You Have: Education and Experience Required Associates degree; and At least four years as a provider services representative or similar role in a health plan; or Equivalent combination of education and experience.
Preferred Bachelor’s Degree Licenses, Certifications Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.
What You Will Get: HPSJ Perks: Competitive salary Robust and affordable health/dental/vision (90% paid medical for employees and 100% paid dental/vision for employees) with choices in providers Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays) CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan Two flexible spending accounts (FSAs) Employer-Paid Term Life and AD&D Insurance Employer-Paid Disability Insurance Employer-Paid Life Assistance Program Health Advocacy Supplemental medical, legal, identity theft protection Access to exclusive discount mall Education and training reimbursement in addition to employer-paid elective learning courses.
A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
We are an equal opportunity employer and diversity is one of our core values.
We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve.
Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws.
It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.
Important Notice: This job description is not a contract between HPSJ and the employee performing the job.
The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.