Provider Relations Coordinator

Who we are

About the Role

The Provider Relations Coordinator (PRC) provides support to the Provider Relations Department to ensure Community Health Plan of WA meets regulatory requirements and other administrative tasks. The PRC will assume the duty of operational support to optimize workflow procedures for the department.

To be successful in this role, you:

• Have minimum of two (2) years in an administrative setting required, preferably in the Health Care Industry or in a Managed Care Organization.
• Have experience in project coordination, showcasing the ability to plan, organize, and execute tasks efficiently to support the teams in various initiatives, including internal and external meetings, training programs, and compliance activities.
• Have experience and familiarity with at-risk populations, communities of color and local resources for persons with behavioral and/or physical health needs.

Essential functions and Roles and Responsibilities:

• Conduct and track annual provider appointment and after-hours access reviews.
• Monitor, track, collect and file Behavioral Health invoices/encounters and conduct provider outreach to collect missing and/or inaccurate invoices/encounters.
• Monitor and track completion of provider mandatory trainings (i.e., Access, Orientation, SNP-MOC) and maintain provider training attestations. Conduct provider outreach as needed to ensure mandatory provider trainings are completed.
• Monitor and respond to external/internal inquiries via Provider Relations inbox and/or through other sources.
• Maintain and update key provider contacts in OnBase and/or other applicable systems.
• Generate and maintain provider contact lists for provider communications, i.e., annual Provider Surveys, SNP MOC, Workshops.
• Assist with the processes relevant to BH invoice rate increases and WISe regulatory reporting.
• Assist in compiling and organizing monthly provider and member complaints in preparation for analysis.
• Key participant in the Provider Communication Workgroup.
• Assist with tasks relevant to the Annual Provider Workshops and Joint MCO Provider Trainings.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

• Proficient with Microsoft products such as Outlook, Word, Excel and Power Point.
• Effective organizational skills with a systematic approach and excellent record management abilities.
• effective work methods and tools in planning, organizing, and prioritizing work.
• A proven commitment to learning new skills and adapting flexibly to changing goals while promoting and supporting management directives.
• Ability to communicate effectively, both orally and in writing across internal and external customers.
• Ability to work both independently and as part of a team, being self-directed and highly motivated.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn’t perfectly check every box in the job description, we encourage you to apply anyway.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Non-Exempt and is eligible for overtime and has a 5% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

•  Medical, Prescription, Dental, and Vision
•  Telehealth app
•  Flexible Spending Accounts, Health Savings Accounts
•  Basic Life AD&D, Short and Long-Term Disability
•  Voluntary Life, Critical Care, and Long-Term Care Insurance
•  401(k) Retirement and generous employer match
•  Employee Assistance Program and Mental Fitness app
•  Financial Coaching, Identity Theft Protection
•  Time off including PTO accrual starting at 17 days per year.
•  40 hours Community Service volunteer time
•  10 standard holidays, 2 floating holidays
•  Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing

Mental:

• Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.