Provider Network Liaison

Provider Network Liaison
Work on an energetic and innovative team
Make an impact in the community
Telecommuting option for candidates in California

The Provider Network Liaison is responsible for coordination and facilitation of initiatives internally and with HPSM-contracted providers to ensure sufficient network access for HPSM members.

Essential Functions:

Provider engagement and recruiting
• Develop and maintain an understanding of provider operations and provider priorities, for the provider specialty areas or provider groups assigned to you.
• Facilitate internal and provider outreach and develop communication materials to support provider learning collaboratives.
• Independently develop and maintain relationships with providers and providers’ office staff.
• Contribute to provider recruitment efforts to support network development programs, including:
o Scheduling and conducting provider visits.
o Clearly communicating the benefits of working with HPSM, tailored to specific providers or provider types.
o Documenting, summarizing and reporting information learned from provider visits about provider needs.

Provider education and process improvement
• Produce and disseminate clear information and reporting dashboards to educate and engage providers and internal staff about payment models, provider contracts, and HPSM provider program requirements.
• Independently conduct online webinars and in-person workshops to familiarize providers with HPSM procedures and processes. Conduct individual provider follow up as needed.
• Coordinate activities among multiple clinical settings and stakeholders using a strong project management toolkit to achieve program goals
• Analyze needs and provide recommendations about ways to incentivize and improve member health outcomes.
• Support HPSM Quality initiatives by encouraging provider participation, and offering provider education when needed.
• Contribute to ongoing process improvement by developing and/or implementing Provider Services processes to support program and department goals.
• Stay current with DHCS, CMS, and DMHC policy updates and changes.
Provider issue resolution
• Diplomatically and creatively resolve escalated or complex provider issues using strong professional judgment and discretion.
Topics for resolution may include:
o Provider payment disputes that could not be resolved through standard claims dispute processes.
o Authorization concerns that could not be resolved through standard Health Services processes.
o Issues between providers and members that could not be resolved through standard Customer Support or Care Coordination processes.
• Serve as a department contact regarding provider grievances, working independently to elicit provider responses in a timely manner and performing root cause analysis to reduce future potential grievances.
• Professionally represent Provider Services/HPSM in internal and external meetings.
• Work independently using sound professional judgement to meet deadlines and prioritize competing needs.

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.

Education and experience
• Bachelor’s degree in a health related field or similar field (strongly preferred)
• Two (2) to three (3) years of experience in insurance, healthcare, or related field (required)
• Experience working directly with providers (strongly preferred)

Knowledge of:
• Population health management principles (required)
• Value-Based payment methodologies (required)
• Process improvement methodology (required)
• Marketing and communications principles (required)
• Conflict resolution approaches (required)
• Insurance claims and billing procedures (preferred)
• Managed care protocol (preferred)
• Medi-Cal and Medicare (preferred)
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint (strongly preferred)

Ability to:
• Perform research and clearly summarize information
• Communicate easily and effectively with large groups or individuals, including comfort communicating with senior provider leadership, both verbally and in writing

• Handle complex issues with diplomacy
• Demonstrate a friendly and professional demeanor under sometimes stressful situations
• Establish and maintain cooperative working relationships with coworkers and external stakeholders
• Be proactive and demonstrate initiative; work independently; use good judgment to make sound decisions
• Interact well with a variety of people and work effectively as part of a cross functional team
• Be detail oriented and accurate
• Organize and prioritize tasks and deliver results within set deadlines

Salary and benefits

The starting salary range depends on the candidate’s work experience.

Excellent benefits package includes:
• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

To apply, submit a resume and cover letter to

Health Plan of San Mateo (HPSM) is a local County-funded nonprofit manages the health care for over 140,000 low-income people San Mateo County, including all its Medi-Cal eligible residents. HPSM is proud to be an Equal Opportunity Employer and an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

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