Provider Services Representative I - Placerville

The expected pay range is based on many factors such as geography, experience, education, and the market.
The range is subject to change.
Health Plan of San Joaquin is now expanding in El Dorado & Alpine counties! Location: Hybrid.
Office location in El Dorado County.
What You Will Be Doing: As our Provider Services Rep I, under direct supervision, you will be responsible for the administration of provider services and related activities in assigned areas.
Location: El Dorado/Alpine Counties Our Vision: Continuously improve the health of our community.
Our Mission: We provide healthcare value and advance wellness through community partnerships.
Essential Functions: Monitors, researches, and addresses provider and administrative inquiries, operational issues, outcomes and trends; prepares and submits findings and recommendations; primary point of contact for incoming provider calls.
Monitors, addresses and/or escalates PLOGS, faxes, incidents, service requests, mail, and other incoming/outgoing correspondence; ensures necessary actions are taken to resolve related issues.
Coordinates mass membership moves, determines new providers to absorb membership, obtains approvals and facilitates changes.
Monitors and reports on member assignments, including but not limited to provider membership assignment capacity and group/individual provider affiliation.
Documents requested contract changes, provider grievances, provider demographic changes, and claims, financial and other issues; forwards to appropriate departments to be addressed.
Collaborates with internal and external stakeholders to ensure the integrity, validity and timeliness of documents and data.
Assists with preparation of New Provider Orientation presentations and packets, and other items as necessary.
Creates, maintains, and publishes periodic and ad hoc reports and arranges for distribution; reviews and validates provider related reports.
Develops and maintains materials and other documents; distributes and communicates to stakeholders in a timely and effective manner.
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.
What You Bring: Knowledge, Skills, Abilities and Competencies 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.
Basic understanding of the importance of the relationships between providers and HPSJ.
Basic knowledge of provider and/or facility contract and payment structures, and reimbursement practices, including capitation.
Basic knowledge of database concepts and terminology.
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 conflict resolution skills, including the ability to use tact and diplomacy to diffuse emotional situations.
Strong oral and written communication skills, including the ability to communicate professionally and persuasively, and effectively explain complex information.
Basic public speaking and presentation skills.
Strong listening skills, with the ability to accurately receive and understand messages.
Time management and organizational skills.
Uses time effectively and efficiently.
Values time.
Concentrates 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.
Demonstrates a commitment to HPSJ’s strategy, vision, mission, and values.
Ability to work independently and as part of a team.
Basic mathematics skills.
Intermediate skills in Word and Excel.
Basic skills in Windows, Outlook, and PowerPoint.
Ability to enter, manipulate, extract, and generate reports from relational databases.
Ability to treat confidential information with appropriate discretion.
Ability to speak and be understood in English.
What You Have: Education and Experience Required Associate’s Degree; and at least two years in a similar position; or equivalent combination of education and experience.
Preferred Bachelor’s Degree Experience in managed care and/or Medi-Cal 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 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.