Provider Relations Representative

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Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

This external facing position must demonstrate high levels of professionalism, while working independently to manage provider relationships. Maintain positive public relations with provider groups, hospitals, clinic administrators, and staff across all business lines. Act as a personal contact for training, materials distribution, and as an information resource. Act as a leading resource for cross functional, complex problem-solving.

Essential Responsibilities:

• Develop and maintain positive working relationships with all assigned provider groups and their staff to ensure that providers’ concerns are addressed in a timely manner.
• Visit newly contracted and established provider groups for on-site service calls to update office staff on PacificSource products, provider manual, provider contract, administrative and claims procedures, and current coding issues pertaining to all business lines.
• Provide proactive and reactive provider education and necessary training including the secure portal InTouch for Providers.
• Distribute a variety of claims analysis reports and other educational information pertaining to the provider’s practice.
• Act as a liaison between PacificSource and contracted providers to resolve complex issues, aid in understanding of provider contracts, and resolve compliance inquiries.
• Document problems, issues, and resolution in provider files or call tracking as needed in CHRM/HIVE.
• Audit participating provider set-ups.
• Attend and present on behalf of PacificSource at provider-related conferences or vendor events, annual workshops, or webinar training events.
• Research and resolve Access to Care concerns with providers to ensure regulatory compliance.
• Issue, monitor, and communicate on provider corrective action plans as necessary.
• Identify and report FWA concerns, assisting SIA team with research as needed.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: 3 years of experience in provider relations or other related healthcare role required.

Education, Certificates, Licenses: Associate’s degree in related field or equivalent combination of education and experience required. CPC certification is preferred. Valid driver’s license required.

Knowledge: Excellent written and oral communication, including diplomacy skills for working with the medical professional community as well as the members enrolled in a PacificSource plan. Ability to effectively explain administrative and claims procedures to provider office staff of varying educational backgrounds and familiarity with insurance billing. Basic math skills required, including percentages, ratios, graphing and spreadsheet skills. Ability to read, understand and communicate PacificSource policy. Effective problem-solving skills. Ability to present to large audiences, in person or virtually. Ability to read, understand, and communicate provider contractual agreements. Medical terminology proficiency. Experience or education in ICD-10-CM and coding. General computer, word processing and spreadsheet skills. General clerical skills. Ability to remain current on PacificSource administrative and claims procedures, healthcare and the health insurance industry, and claims coding issues. Excellent public relations skills. Ability to prioritize work.

Competencies

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 30% of the time, or as needed to complete minimum requirements for site visits, workshops, and provider education.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.