USA

Provider Services Representative

Honolulu - Hawaii (HI), 96814

AlohaCare

Job Description:

Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

Position Summary:

Serves as a provider liaison with responsibilities including implementing strategic retention, recruitment, and educational activities to support AlohaCare’s provider network related goals. Represent AlohaCare in a highly professional manner consistent with organizational values and branding objectives. Participate in on-going identification and adaptation of processes and practices to meet organizational objectives. Gathers and reports information that strengthens AlohaCare’s ability to proactively address provider issues.

Primary Responsibilities:

Communication

  • Supports department participation in organizational efforts such as open enrollment, quality initiatives, NCQA accreditation, MQD readiness, HSAG audits and other activities.
  • Supports production of reports including fulfillment of state contractual requirements and organizational needs.
  • Contributes to the coordination, development and execution of communication products such as surveys, directory, manual, handbook, website, newsletters and provider advisories.
  • Seeks and shares industry information that informs AlohaCare of current issues in the health industry and communities we serve.
  • Represent AlohaCare at external provider events including exhibit booths, conference and meetings.

Retention of Providers

  • Schedules and meets with providers and/or staff in assigned territory.
  • Records daily contact of visits and interactions with providers in a shared database.
  • Supports implementation of strategic provider network retention efforts.
  • Serves as the main point of contact for the resolution of provider issues, as needed, including internal process
improvement, authorizations, complaints, benefits, contracts, fees and other issues.

Recruitment of Providers

  • Coordinates activities for the proactive identification and pursuit of contracts with providers to participate in AlohaCare’s network based on department priorities.
  • Identify and assists in the resolution of barriers to contracting with priority providers.

Education of Providers

  • Coordinates and conducts provider educational and training activities including presentations in large and small group, one-on-one and online settings.
  • Assists in the development of educational and training materials and logistical arrangements for education and training events.

Other/Secondary Responsibilities

  • Implement solutions to proactively address provider network issues on Oahu.
  • Facilitate inter-departmental collaboration for projects, process improvement and on-going operations.
  • Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title

Required Competencies & Qualifications:

  • High school diploma or equivalent
  • Minimum of three years customer service, one year healthcare, or comparable experience
  • Current valid Hawaii driver’s license and access to an insured vehicle
  • Strong verbal and written communication skills, including public speaking and interpersonal interaction
  • High energy level and ability to perform repetitive tasks in a fast paced work environment.
  • Flexibility and adaptability to changing priorities.
  • Intermediate skill using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
  • Ability to think critically with strong multi-tasking skills

Preferred Competencies & Qualifications:

  • Bachelor’s degree.
  • Provider and/or health plan experience
  • Medicaid and/or Medicare experience.

Working Conditions/Physical Demands:

  • Inside working conditions.
  • No environmental hazards.
  • Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
  • Requires occasional inter-island travel with occasional overnight stays
  • Requires verbal and written communication in English

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

Job Type: Full-time

Salary: $0.00 /hour

Experience:

  • healthcare, or comparable: 1 year (Required)

Location:

  • Honolulu, HI (Required)

License:

  • valid driver (Required)

Work Location:

  • One location

Benefits:

  • Health insurance
  • Dental insurance
  • Vision insurance

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