Provider Relations Administrator

Who We Are

Innovative Integrated Health (IIH) is a mission-driven healthcare organization dedicated to helping frail, underserved, and multiethnic seniors live safely and independently at home with dignity. Through the Program of All-Inclusive Care for the Elderly (PACE) model of care, we deliver high-quality, personalized healthcare and supportive services that improve quality of life across the communities we serve.

At IIH, our work is rooted in compassion, cultural understanding, and deep respect for those in our care. Team members play a vital role in supporting seniors throughout Central and Southern California—delivering care that’s not only clinically excellent, but also personal, coordinated, and community-based.

When you join IIH, you become part of a team committed to making a real difference in the lives of older adults—every single day.

Benefits

• 401(k) 
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid sick time
• Paid time off
• Referral program
• Retirement plan 

Job Summary

The Provider Relations Administrator is responsible for developing and maintaining service relationships with all PACE participants including physicians, patients/participants, outside physicians and administrators. Responds to electronic and direct inquiries from clients about policies, reimbursement rates, patient referrals, eligibility and credentialing. The Provider Relations Administrator will work on special projects such as: telehealth, process improvement, community outreach and community engagement, in a supportive role for the effectiveness of the PACE Program. The Provider Relations Administrator manages the credentialing and re-credentialing process. Develops and maintains processes for renewals and processes them timely. The Provider Relations Administrator knows and abides by all PACE Program organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments. Performs job duties in a timely manner, and represents the organization in a professional and positive manner.

Essential Job Functions

Duties include,but are not limited to:

• Serves as liaison between providers and PACE participants.
• Receives and responds to external provider and participant related issues.
• Develops workflows, strategies, and special projects to meet participant care needs.
• Oversees the implementation plan of Telemedicine between the PACE Program, participants and specialty physicians.
• Provides participant education and participant support in Telemedicine service line.
• Ensures the effectiveness of Telemedicine and maximize the use of Telemedicine for clinical and educational services.
• Represents and promotes the knowledge of PACE to the community.
• Responsible for maintaining confidentiality and providing excellent customer service to program enrollees, their families or designated representative.
• Provider relations consists of several diverse provider contract administrative duties including; direct provider engagement and training, regularly scheduled service visits with targeted providers, network capability monitoring, limited-service contract negotiations and resolution of participant/PACE issues.
• Responds to general provider contract inquiries
• Responds to provider education needs and non-routine claim issues. May research, analyze and recommend resolution for provider disputes.
• Conducts provider outreach by conducting trainings and guidance to enable network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of available tools.
• Attend and participate in staff meetings, in-services, projects, and committees as assigned.
• Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.
• Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
• Be flexible in schedule of hours worked.
• May require use of personal vehicle

Education and Qualifications:

• A Bachelor’s degree preferred.
• Minimum of three (3) years of demonstrated experience in the healthcare field.
• Minimum of one (1) year of documented experience working with a frail or elderly population.

Knowledge, Skills and Abilities

• Proficient knowledge of computer skills. MS Office (Word, Excel, Access, PowerPoint, and Outlook).
• Knowledge of general office procedures, equipment and filing systems.
• Ability to communicate effectively, both orally and in writing.
• Ability to quickly learn department policies, procedures, goals, and services.
• Skill: Attention to detail and accuracy.
• Ability to change priorities regularly.

Working Conditions and Physical Demands

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to access all areas of the center throughout the workday.
• Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance of another qualified employee when attempting to lift or transfer objects over 25 pounds.
• Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling.
• Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment.

Core Values

• Respect at the core of our interactions.
• Honesty and Integrity with every endeavor
• Patient – Centered care aligned with participant values, beliefs, and preferences.
• Encouragement that motivates and empowers others to be the best they can be.
• Quality Care that is efficient, transformative and innovative.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.