PROVIDER ADVOCATE CENTRAL VALLEY (TULARE, FRESNO, KINGS AND MADERA COUNTY)

POSITION SUMMARY:

Under the direction of the Provider Services Director, the Provider Advocate is responsible for conducting on-site visits to Primary Care Physician (PCP), Specialty Care (SPC) and Ancillary Providers to insure Providers have and are utilizing the appropriate tools to provide care to the patients under LaSalle Independent Physician Association (IPA). Provider Advocate will develop a relationship with Provider and Provider staff and be a support system when needing assistance with contracting questions, claims assistance, utilization support and credentialing. In addition, Provider Advocate will train providers on the use of the portal and other tools to assist with patient eligibility, line of business, etc.

ESSENTIAL FUNCTIONS:

Maintain the PCP, SPC and Ancillary Network. This includes maintaining existing relationships and obtaining new ones.

Augmenting the Network of PCPs to grow new business.

Review areas of improvement for the SPC and Ancillary Network in order to maintain a strong network and be in compliance with Network adequacy standards from the health plans.

Generating contractual agreements and assisting in contract negotiations.

Able to explain Division of Financial Responsibilities to the Network.

Serving as a resource for Providers, internal staff and external partners to interpret and explain contract terms and conditions.

Able to comprehend and explain Federal and State Legislations to Provider Network.

Monitor, report and improve compliance with policy and services standards.

Provides education and training to Provider Network and assist in completing attestations for the health plans.

Acts as a liaison between IPA, health plans and LaSalles’s Maintenance Service Organization (MSO).

Conducts claims audits and support Provider staff on areas of improvement.

Supply system trainings and reviews handouts, materials, and current health plan guidelines.

Support Providers when having claim challenges and become a liaison between Provider and MSO.

Assist Providers when needed on credentialing documentation to insure a smooth credentialing process.

Lead Joint Operation Meetings with Providers. Also, participate in Health Plan meetings.

Travel required throughout the region. Driver’s License and Proof of Insurance is required.

KNOWLEDGE, SKILLS AND ABILITIES (minimum qualifications):

Must have a HS Diploma or GED equivalent. Bachelor’s Degree preferred.

Ability to interpret agreements and understand compensation structures.

Knowledge of Medi-Cal, MediCare and Commercial coverage.

Great communication skills with staff, providers and patients.

Exhibit flexibility when work assignments need to be adjusted.

Outstanding organizational skills and able to multitask.

Knowledgeable with MS Office, Excel, PowerPoint, etc.

Commitment to Team culture

PHYSICAL DEMANDS:

The 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. While performing the duties of this job, the employee is regularly required to walk, sit, bend, and lift 1-10 lbs. of computer parts. The use of hands, fingers, and to be able to reach with the hands and arms is required.

WORK ENVIRONMENT:

Provider Advocate works in a clean clinical environment with ergonomically designed keyboards and counters. To prevent lifting strain injuries, use proper methods and ask for assistance if needed. Take regularly scheduled meal period and rest breaks.

Job Type: Full-time

Pay: $73,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Supplemental Pay:

• Bonus opportunities

Experience:

• Managed Care: 1 year (Preferred)
• Medical Terminology: 1 year (Preferred)

Ability to Relocate:

• Fresno, CA 93711: Relocate before starting work (Required)

Willingness to travel:

• 75% (Preferred)

Work Location: In person

Salary : $73,000