North East Medical Services
PROVIDER NETWORK LIAISON
North East Medical Services, Burlingame, California, United States, 94012
Overview
Provider Network (PN) Liaison role at
North East Medical Services . The PN Liaison, in conjunction with the MSO Provider Network team, is responsible for activities and actions related to promoting the services and expertise of NEMS’ network and MSO services to the medical community, as well as providing the community with ongoing education regarding the NEMS managed care services. Responsibilities
Develop new and maintain existing business relationships with community organizations, physicians, and healthcare administrators via in-person outreach activities according to pre-determined targeted market or geographic area. Plan and conduct independent in-service meetings that highlight the features and benefits of the NEMS network and promote NEMS MSO services while responding to complex provider inquiries and addressing concerns. Represent NEMS MSO at networking and community events throughout an assigned territory. Exercise discretion and independent judgment to address complex authorizations, claims, provider appeals, benefit coverage issues raised by physician practices during outreach events, and coordinate follow-up activities via virtual or in-person meetings for resolution. Conduct orientation, training, and education sessions to contracted provider entities and business associates, providing general guidelines of the Medicare and Medi-Cal managed care program requirements via virtual and in-person meetings. Assist in interpreting MMCD policy and DHCS APL (All Plan Letter) and communicate policy changes to community providers and organizations for implementation within the required timeframe. Assist with workflow training to new team members to ensure understanding and adoption of the NEMS MSO network and programs. Participate in the design and development of marketing materials including brochures, flyers, newsletters, and other managed care related information. Complete provider outreach/visits logs and submit them in a timely manner to the Provider Network Operations Manager. Collaborate with internal and external parties for implementation of audit findings. Performs other job duties as required by manager/supervisor. Qualifications
BA/BS degree; Associate Degree may be considered with relevant, equivalent work experience. 4 years work experience in healthcare setting in the areas of provider network, claims, or utilization management is preferred. Prior experience in a managed healthcare setting, provider organization with knowledge of CMS and/or DHCS health policy is preferred. Knowledge of Medicare and/or Medi-Cal managed care program and/or other state-sponsored program is a plus. Superior ability to communicate (spoken and written) effectively with a variety of professionals, including physicians and other healthcare providers. Must be PC literate – strong Excel, Word, PowerPoint, and Outlook skills; Knowledge of community resources and cultural considerations is a plus. Detail-oriented and organized with the ability to interpret DHCS policy letters and make decisions. Good organization and problem-solving skills. Ability to self-manage and work with multiple departments within the organization and external clients. Language
Must be able to fluently speak, read and write English. Fluent in Chinese (Cantonese and/or Mandarin) preferred Fluency in other languages are an asset. Status
This is an FLSA exempt position. This is not an OSHA high-risk position. This is a full time position. NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).
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Provider Network (PN) Liaison role at
North East Medical Services . The PN Liaison, in conjunction with the MSO Provider Network team, is responsible for activities and actions related to promoting the services and expertise of NEMS’ network and MSO services to the medical community, as well as providing the community with ongoing education regarding the NEMS managed care services. Responsibilities
Develop new and maintain existing business relationships with community organizations, physicians, and healthcare administrators via in-person outreach activities according to pre-determined targeted market or geographic area. Plan and conduct independent in-service meetings that highlight the features and benefits of the NEMS network and promote NEMS MSO services while responding to complex provider inquiries and addressing concerns. Represent NEMS MSO at networking and community events throughout an assigned territory. Exercise discretion and independent judgment to address complex authorizations, claims, provider appeals, benefit coverage issues raised by physician practices during outreach events, and coordinate follow-up activities via virtual or in-person meetings for resolution. Conduct orientation, training, and education sessions to contracted provider entities and business associates, providing general guidelines of the Medicare and Medi-Cal managed care program requirements via virtual and in-person meetings. Assist in interpreting MMCD policy and DHCS APL (All Plan Letter) and communicate policy changes to community providers and organizations for implementation within the required timeframe. Assist with workflow training to new team members to ensure understanding and adoption of the NEMS MSO network and programs. Participate in the design and development of marketing materials including brochures, flyers, newsletters, and other managed care related information. Complete provider outreach/visits logs and submit them in a timely manner to the Provider Network Operations Manager. Collaborate with internal and external parties for implementation of audit findings. Performs other job duties as required by manager/supervisor. Qualifications
BA/BS degree; Associate Degree may be considered with relevant, equivalent work experience. 4 years work experience in healthcare setting in the areas of provider network, claims, or utilization management is preferred. Prior experience in a managed healthcare setting, provider organization with knowledge of CMS and/or DHCS health policy is preferred. Knowledge of Medicare and/or Medi-Cal managed care program and/or other state-sponsored program is a plus. Superior ability to communicate (spoken and written) effectively with a variety of professionals, including physicians and other healthcare providers. Must be PC literate – strong Excel, Word, PowerPoint, and Outlook skills; Knowledge of community resources and cultural considerations is a plus. Detail-oriented and organized with the ability to interpret DHCS policy letters and make decisions. Good organization and problem-solving skills. Ability to self-manage and work with multiple departments within the organization and external clients. Language
Must be able to fluently speak, read and write English. Fluent in Chinese (Cantonese and/or Mandarin) preferred Fluency in other languages are an asset. Status
This is an FLSA exempt position. This is not an OSHA high-risk position. This is a full time position. NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).
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