Hybrid Field Representative

Summary

Under the general direction of the Provider Network Operations (PNO) Lead, Field Representative, the PNO Field Representative develops relationships and serves as a liaison for providers within the Client IPA’s provider network. This role includes educating providers on client protocols, ensuring compliance with regulations, resolving concerns, documenting resolutions, and identifying training needs. The candidate should have knowledge of authorizations, claims functions, and credentialing processes.

Duties and Responsibilities: 

• Conduct orientations and ongoing education for providers to ensure compliance with IPA programs and effective use of company tools like the MPM Portal.
• Assist in implementing policies, procedures, and training programs for providers.
• Distribute and update provider onboarding materials and bulletins to keep offices informed.
• Identify and address provider needs proactively, working with management and internal teams to resolve issues.
• Maintain logs, coordinate credentialing applications, and resolve grievances in accordance with policies and regulations.
• Engage with providers through various channels and ensure contract compliance with regulatory agencies.
• Act as a liaison between departments and participate in key meetings to support network and company success.
• Understand and follow the Employee Handbook policies and procedures.
• Ensure HIPAA compliance is observed/performed at all times.
• Perform other duties/assignments as needed.

Minimum Job Requirements:

• Bachelor’s degree in healthcare, human services or related field preferred
• 3+ years Managed Care or Healthcare experience
• Must have reliable transportation
• EZ-CAP knowledge preferred
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
• Substantive knowledge of the HMO marketplace including Medi-Cal, Commercial, and Medicare

Skills and Abilities:

• Establish and foster collaborative relationships through clear verbal and written communication
• Exhibit excellent active listening, critical thinking, and problem-solving skills
• Engage providers with professionalism, confidence, and sincerity
• Develop and present effective training materials
• Demonstrate strong time management, organizational, and multitasking abilities
• Self-motivated with the ability to provide and receive constructive feedback
• Deliver consistent customer service with the ability to resolve complaints and concerns

Salary Range:

• $66,560 - $75,000 annually