Provider Relations Representative - Oahu

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

The Company:

AlohaCare is a local, non-profit health plan serving Hawai`i’s low-income residents with free Medicaid and dual Medicare health insurance coverage. Our members include children, seniors and adults residing on all islands. We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care. Our approach is to meet the whole-person health and social needs of members. Through our community partnerships we offer innovative services such as connection to social service agencies, Native Hawaiian healing services and in-home primary care for qualified members. Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all. We are Hawaii’s third-largest health plan and offer a wide network of quality primary care, specialists, hospitals, pharmacies and among many other providers across the state.

The Culture:

AlohaCare employees have a passion for helping Hawai`i’s most underserved communities. Our caring culture is fundamental to our company-wide team approach to providing high quality services. We support our employees with 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 by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

The Opportunity:

The Provider Relations Representative, Oahu 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 Duties and 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, conferences 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, and one-on-one in-person 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.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Responsible for maintaining 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

Requirements:

• High school diploma or equivalent
• Minimum of 3 years of customer service, 1 year of healthcare, or comparable experience
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization.
• Strong, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
• Professional telephonic etiquette skills.
• Ability to solve problems, analyze, think critically and make good judgment.
• Strong customer service skills and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
• Able to work independently with minimal supervision.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
• Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Intermediate skill using Microsoft Programs: Word, Excel, Outlook and PowerPoint.
• Possession and maintenance of valid driver’s license with access to a reliable insured automobile and acceptable driving record.

Preferred Requirements:

• Bachelor’s degree or equivalent combination of education and experience.

• Provider and/or health plan experience
• Medicaid and/or Medicare experience.

Mental, Physical and Environmental Demands:

• 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.
• Field working environment, including frequent travel in personal vehicle to client and other locations throughout the island.
• May require prolonged sitting- up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.?

• Requires occasional inter-island travel with occasional overnight stays

Salary Range: $50,000 - $65,000 annually

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/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.