What are the responsibilities and job description for the Provider Relations & Contracting Specialist position at Adventist Health?
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus — a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Develops and maintains positive provider relationships with community providers by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues. Assists in the full range of provider relations and service interactions within the Adventist Health Plan and Adventist Health care network. Coordinates with contracted Management Service Organization (MSO) to assist with provider inquiries.
Job Requirements:
Education and Work Experience:
- Associate’s Degree in healthcare/business or equivalent combination of education/related experience: Required
- Bachelor's Degree in business administration, health care administration or other related field: Preferred
- Three years' experience in health care field interacting directly with providers: Preferred
- Managed care experience: Preferred
Licenses/Certifications:
- Valid Driver’s License (DL) and must be at least 21 yrs of age or older: Required
Essential Functions:
- Develops and manages trusting relationships with key providers by coordinating and facilitating meetings. Completes new provider orientation for all applicable product lines. Exhibits understanding and sets priorities to handle multiple tasks simultaneously, and designs work plans to track progress, resolve issues, and efficiently and effectively see tasks to completion. Coordinates with contracting manager on network needs to perform recruitment.
- Coordinates with other departments to ensure provider compliance with contractual obligations. Ensures provider education and communication compliance requirements are met and participates in activities related to plan compliance. Collaborates with partners and various departments on network expansion efforts to ensure provider onboarding is completed.
- Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction. Coordinates prompt resolution to provider issues through direct contact with providers and internal management.
- Achieves calls/outreach and frequency goals to establish consistent and strong relationships with provider offices. Assists in monitoring of provider performance and communicating feedback to improve quality of service. Performs outreach, monitoring and resolution of provider inquiries.
- Conducts site visits to service providers, resolves issues, collects credentialing information, and participates in quarterly joint operations meetings.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
