Provider Relations Specialist

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California 

***This position is hybrid.

Position Summary:

The Provider Relations Specialist is responsible for establishing and maintaining positive relationships with various providers across all markets in the Value Hub, building strong, cohesive partnerships. The role is responsible for driving provider engagement and strong communication, supporting network development, managing and improving provider performance, sharing data and insights, and supporting the implementation of quality and care initiatives in partnership with other teams across the Value Hub. Works with internal staff, and other contracted entities to deliver contractual performance standards and ensure customer service objectives are continually met.

Responsibilities may include:
- Develop and maintain effective communication channels with providers, ensuring they are well-informed on key policies, programs, and updates.
- Act as the primary point of contact for providers, addressing their queries, concerns, and feedback promptly and professionally.
- Establish and maintain positive relationships, negotiate favorably, collaborate with others, and build consensus both externally and internally to achieve desired results.
- Mediate conflicts support issues between providers, the Value Hub, and/or health plans ensuring resolutions that align with the network's goals and values
- Conduct ongoing educational training to ensure providers remain compliant and aware of organizational and industry procedures and policies
- Conduct regular site visits to providers' practices to assess their needs and offer tailored support and resources
- Identify and recruit new providers to join the network, in alignment with Value Hub and National strategy, ensuring they meet the network's quality standards and criteria.
- Support provider onboarding and orientation as new providers join the network
- Understand and answer inquiries regarding arrangements contracted with health plans, including plan description, benefit summaries, internal operations workflows, authorizations, and policies & procedures.
- Monitor and evaluate provider performance against established benchmarks and quality metrics, utilize data to identify trends, gaps, and opportunities for network improvement.
- Provide actionable feedback and suggested plans or interventions to support to providers, helping them improve their performance and comply with quality standards.
- Demonstrate ability to understand and interpret laws, rules and regulations as defined under state and Federal statutes along with remaining current on Healthcare Reform updates and changes.
- As applicable, demonstrate familiarity with eligibility, prior authorization, claims administration and provider network administration.
- Understand and interpret regulatory concerns as applicable to new and existing contractual agreements with providers, including HIPAA privacy and security, CMS rules and regulations, and ERISA.
- Communicate effectively with all levels of internal/external staff, management, clients, physicians and physician office staff.
- Create professional documents and presentation using proper grammar, punctuation and appropriate reading level proficient in the use of Microsoft Office applications; Excel, Word, Access, Outlook, PowerPoint, Project.
- Work as part of a team, including other teams within the PHSO and Value Hubs, to ensure continue improvement around network operations and to meet established organizational objectives.

Minimum Qualifications:

- Experience in marketing, sales or customer service in a health care setting required.
- Bachelor’s degree and/or equivalent experience OR 3 or more years' experience working in a similar position in the healthcare industry; or an equivalent combination of training and experience that provide the capabilities needed to perform the job duties. The Provider Relations Representative must have the ability to handle various situations in a professional manner, demonstrating excellent customer service at all times and ability to adapt to change.
- Willingness to work as part of a team, working with others to achieve goals, solve problems, and meet established organizational objectives.
- Strong business acumen, customer service skills, follow-up, organizational and project management skills to ensure objectives and deadlines are consistently met.
- Valid driver’s license and/or reliable transportation required for travel
- Ability to establish and maintain positive business relationships, negotiate favorably, collaborate with others, and build consensus both externally and internally to achieve desired results.
- Demonstrated ability to understand and interpret laws, rules and regulations as defined under state and Federal statutes along with remaining current on Healthcare Reform updates and changes.
- Ability to understand Summary Plan Descriptions, Benefit Summaries, internal operations workflows, and claims policies & procedures.
- Strong problem-solving abilities.
- Ability to identify issues and problems within administrative processes activities, and other relevant areas.
- Familiarity with value-based care health arrangements and programs.
- Ability to understand insights and trends from dashboards and analyzed data outputs to share and recommend practice and operational improvement opportunities to providers.
- Ability to maintain strict confidentiality at all times.
- Ability to continually re-prioritize to meet the needs of internal and external customers throughout the workday.
- Thorough knowledge of generally accepted professional office procedures and processes.

Preferred Qualifications:

- Experience working as an account manager in value-based programs preferred.