PROVIDER RELATIONS REPRESENTATIVE
Company: River City Medical Group
Location: Sacramento
Posted on: January 14, 2021
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Job Description:
Who We AreRiver City Medical Group (RCMG) is one of the largest
Medi-Cal Independent Physician Associations in Northern California,
serving approximately 275,000 Medi-Cal patients spanning nine
counties: Sacramento, Butte, Colusa, Glenn, Nevada, Placer, Sutter,
Tehama, and Yuba. RCMG provides its patients with quality care
through its vast and diverse contracted network of primary care
physicians, specialists and ancillary providers.RCMG is an active
member of the community helping to support it in our professional
roles as an IPA. With the robust leadership of local practicing
physicians, we are committed to ensuring our members and physicians
are supported to provide the right care at the right time.* A
dedicated team implementing creative solutions to assist providers
with focusing more on patient care and less on administration*
Community relations developing public and private partnerships that
improve access to care and link members to services* Doctors
providing care to almost 1 in 2 Medi-Cal Beneficiaries in the
Sacramento area* Only IPA based in Sacramento County exclusively
dedicated to serving the Medi-Cal populationIt is the policy of
RCMG to provide equal employment opportunity (EEO) to all persons
regardless of age, color, national origin, citizenship status,
physical or mental disability, race, religion, creed, gender, sex,
sexual orientation, gender identity and/or expression, genetic
information, marital status, status with regard to public
assistance, veteran status, or any other characteristic protected
by federal, state or local law. In addition, RCMG will provide
reasonable accommodationfor qualified individuals with
disabilities.Job Summary:Works closely with the provider community
to identify and resolve issues, provide education and staff
training, and ensure that providers are in compliance with the
regulatory agencies set forth in River City Medical Group's (RCMG)
contractual agreements. Maintains accuracy of bulletins and
communications with provider offices. Interface with HMO liaisons
on provider issues. Assists with provider network contracting
activities.Essential Job Functions:* Reasonable accommodations will
be made to enable individuals with disabilities to perform the
essential functions of the position.* Assist in development of
physician visit policies and procedures to include visits, new
providers orientation, implementation of new policies, and
providing assistance to new physicians' and office staff as
needed.* Document and file visitation records, and report on a
regular basis to the Provider Relations Supervisor. Assists with
the development and implementation of provider training programs.*
Provide education and staff training to provider offices of all
applicable IPA and HMO guidelines. In conjunction with the UM
department, works closely with the provider community to identify
and resolve issues and ensure compliance with rules, regulations,
and audits.* Effectively integrate new programs and strategies per
member per month targets, and provide oversight to the provider
setup and contract configuration to ensure accurate claims
processing.* Perform financial analysis to identify medical cost
improvement opportunities, develop strategies to reach financial
goals, and execute contracting strategies to meet goals and
objectives.* Evaluate and monitor providers' performance standards
and financial performance of contracts. Produce, maintain, and
ensure accuracy of IPA provider onboarding materials, monthly
updates, and bulletins to keep provider offices informed of all
changes.* Analyzes changing business; makes recommendations to
management for process improvements as required. Informs the
Provider Relations Supervisor of operational problems and request
resolutions in a judicious manner.* Proactively identify provider
needs and advise management so that action can be taken to address
the needs before they are problematic for the provider.*
Coordinates, attends, and participate in various meeting as
assigned.* May be required to report on major points, actions
resolved or to be taken.* Recruitment of providers in consultation
with Provider Relations Supervisor.* Assist in provider
contracting. This may include identification of new provider,
standard contracting of primary care physicians, delivery of
provider contract and all pertinent information for credentialing
requirements.* Responsible for maintaining updated provider visits
and communications.* Reports to Provider Relations Supervisor.*
Maintains a well-documented desk procedure to include the job
tasks, reports, duties of this position in the absence of the
incumbent.* Performs related duties consistent with the scope and
intent of the position.* Regular attendance.* Travel as
required.Other Functions:* Enforces Company policies and safety
procedures.* Regularly updates job knowledge by participating in
educational opportunities, reading professional publications,
maintaining professional networks, and participating in
professional organizations.Competencies* Three years' experience in
the medical industry.* Prefer 2+ years previous provider relations
experience in an IPA, health plan, or health care setting.* Must
have reliable transportation.* Excellent communication skills,
including both oral and written.* Excellent active listening and
critical thinking skills.* Ability to solve mid-level problems with
minimal supervision.* Ability to demonstrate professionalism,
confidence, and sincerity while quickly and positively engaging
providers.* Ability to develop and present training materials to an
audience.* Ability to multi-task, exercise excellent time
management, and meet multiple deadlines.* Ability to provide and
receive constructive job and/or industry related feedback.* Ability
to maintain confidentiality and appropriately share information on
a need to know basis.* Ability to consistently deliver excellent
customer service.* Excellent attention to detail and ability to
document information accurately.* Ability to effectively and
positively work in a dynamic, fast-paced team environment and
achieve objectives.* Demonstrate commitment to the organization's
mission.* Must have mid-level skills in Microsoft software (Word,
Excel, PowerPoint).* Must have the ability to quickly learn and use
new software tools.* Must have mid-level skills using e-mail
applications.* Self-motivated with strong organizational,
multi-tasking, planning, and follow up skills.* Ability to work
independently as well as in a team environment.* Ability to present
self in a professional manner and represent the Company
image.Education and Licensure* Associate degree in a related field*
BA or BS preferred.* The education requirement may be waived based
on years of experience* Current California Driver's License and
Automobile Insurance is required.TravelThe incumbent may travel up
to 50% of the time in the greater Sacramento area.Work
EnvironmentThis job operates in a professional office environment.
This role routinely uses office equipment such as computers,
phones, photocopiers, scanners and filing cabinets.
Keywords: River City Medical Group, Sacramento , PROVIDER RELATIONS REPRESENTATIVE, Other , Sacramento, California
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