We are looking for an applicant that is bi-lingual in Korean, Vietnamese, and/or Chinese (Mandarin/Cantonese) Provider Service Representative.
The Specs.
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Full-Time.- Non-Exempt.
- Fluent in Korean, Vietnamese, and/or Chinese (Mandarin/Cantonese) (read, write, speak)
- Benefits-eligible: Medical, Dental, Vision, PTO, Holidays, and more.
- Monday - Friday.
- Work-life balance.
- Salary Range: $23 - $30 / hour
The Position.
Innovative Management Systems is a management services company focused on finding innovative ways to ensure regulatory compliance, customer services, provider experience, and measurable outcomes in the healthcare industry. Through our ever-evolving data analytics platform, we strive to improve overall medical spending, HEDIS, and STAR measures through a collaborative effort of education, reporting and workflow management. Come be part of the team that helps to improve quality of care, reduce administrative burden, and achieve greatness through creative thinking and educated calculated risks. Be the change in healthcare everyone talks about, but few people achieve. We value our team’s opinions and new ways of getting the job done and are looking for self-starters with fresh ideas, ready to help pave the way to a better tomorrow.
Some Responsibilities.
- Supports the performance and growth objectives of the respective IPAs assigned to the incumbent by engaging with various Health Plans, network Primary Care Providers, Specialists and Members.
- Develops collaborative relations with key stakeholders, IPAs, Health Plans, and Providers offices including but not limited to Providers, office staff, billing offices to improve performance benchmarks and promote growth.
- Conducts initial Provider orientations, education and training via in person, webinar and/or through phone calls.
- Performs annual Health Plan compliance requirements with various offices.
- Disseminations of reports to Physician offices as well as running comparison reports to promote performance improvements and growth.
- Maintains and updates Provider Profiles and data in the system to ensure accurate Provider Rosters for Directories, audits, and network gap analysis.
- Assists with any access to care issues and attempt to mitigate issues through careful review of membership and network assessments.
- Understands day-to-day managed care operations, Risk Adjustment and HEDIS measures.
- Communicates & interacts with Health Plan Representatives and attend JOC
- Collects and track materials, documents and information such as AWEs, Credentialing materials, Attestations, Portal requests.
- Sends out mailings to Providers quarterly to ensure accuracy of network for Directory and Rosters
- Be the “one touch resolution” for Provider and Member inquiries related to but not limited to Utilization Management, Claims, Eligibility, Contracting, and Directory validation for assigned IPA(s).
- Utilizes and work to improve database tracking and dashboard reports
- Conducts regular meetings with IPA clients to review performance reports and area for improvements. timely Credentialing and network growth.
- Conduct regular meetings with IPA clients to review performance reports and area for improvements.
- Performs Special Projects as assigned to help drive company growth and improvement.
IMS offers competitive compensation. We are an equal opportunity employer and seek diversity in our workforce.
Our team at IMS is looking for highly motivated individuals to join our growing start-up. We strive to innovate the healthcare industry by providing management and consultant services to Independent Physicians Associations (“IPAs”) and Health Plans. Our team utilizes their comprehensive knowledge of the healthcare industry to provide quality services for our contracted Medicare members in a fast-paced and multi-faceted environment. Our positions offer an in-depth perspective of the managed care industry to interested candidates that are looking to take risks and share in professional development and growth alongside our expanding company. If you are looking to make an impact in your career, in a flourishing new company, and in the healthcare industry, we welcome you to apply to join our team!
Requirements:The Skills, Knowledge, Experience, and Other Characteristics
- 2 years in Provider Relations or Contracting in Managed Care HMO, IPA or MSO.
- 2 years relevant experience with handling Customer Service’s phone queue, training individuals, and presenting material, or a combination of education and experience.
- Strong verbal and written communication skills to be able to effectively communicate.
- Fluent in Korean, Vietnamese, and/or Chinese (Mandarin/Cantonese) (read, write, speak).
- Strong presentation skills and ability to address a diverse audience appropriately.
- Strong analytic, quantitative and problem-solving skills.
- Proficient in MS Office (Excel, Word and PowerPoint).
- Relationship building, team player and creative problem solver.
- Be a self-starter, solution driven, organized individual who is able to prioritize effectively on their own.
- 50% travelling or reliable means of transportation for in-office and provider outreach.
Licenses/Certifications.
- Valid driver’s license and auto insurance, or reliable transportation needed.
Education.
- High School / GED (required).
