Job Title: Provider Relations Representative
Department: Provider Relations

About the Role:

We are currently seeking a highly motivated Provider Relations Representative. This role will report to the Manager – Provider Relations and enable us to continue to scale in the healthcare industry.

You are:

• Comfortable with ambiguity and biased towards action
• Relentlessly resourceful
• Growth-oriented
• Mission-driven

What You'll Do:

• Develop strong professional relationships with all providers and their staff while functioning as a liaison to the provider community to research and resolve complex provider issues.
• Take ownership of the provider relationship, ensuring all provider needs and concerns are addressed and answered
• Establish regular contact with and visits to provider sites. Visits may include regular operations meetings, staff education, provider orientations, and appreciation events
• Facilitate and lead orientation meetings and communication sessions with key providers; orient providers on policies related to: Claims and service recovery - Program benefits - Clinical initiatives - Referral and authorization - Regulatory compliance - Billing and payments - Complaints and appeals - Policies and procedures - Identify opportunities for training and education. Conduct site visits with contracting, sales and marketing departments to ensure the collection of required applications and other documentation
• Manage and respond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues. Represent the group at provider related events and other initiatives, as necessary
• Prioritize and organize own work to meet deadlines
• Work collaboratively with Provider Network Management staff to ensure an adequate and appropriate provider network. Participate in contracting strategy discussions around potential recruitment opportunities
• Coordinate with other departments, including Clinical Management, Member Services, Regulatory Affairs, Claims and Outreach and Marketing, to resolve provider issues
• Participate in departmental and interdepartmental meetings as appropriate and necessary
• Participate in the development of departmental policies, procedures and processes
• Special projects as assigned or directed
• Maintain professional growth and development

Minimum qualifications:

• An undergraduate degree from an accredited institution of higher learning required; or minimum of three (3) years relevant work experience in Network Management, Provider Relations in a managed care setting, health plan or large medical group administration.
• Excellent oral and written communication skills.
• Detail oriented and possess strong organizational skills in a fast-pace environment.
• Proven in MS Office programs (i.e., Excel, Word, Outlook and PowerPoint)
• Individual must have an understanding of Managed Care Operations (i.e., patient referrals, claims process, eligibility information, contracting, HEDIS, HCC etc.).

Who We Are:

ApolloMed (NASDAQ: AMEH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 10,000 physicians to provide care for over 1.2 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Our Values:

• Patients First
• Empowering the Independent Provider
• Be Innovative
• Operate with Integrity & Deliver Excellence
• Team of One

Environmental Job Requirements and Working Conditions:

• This is an in-person position. The office is located at 823 Jackson Street, San Francisco, CA 94133

• The target pay range for this role is between $18.00 - $36.00 per hour. This salary range represents our national target range for this role.

ApolloMed is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@networkmedicalmanagement.com to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.