PACE HP Provider Relations Specialist (Central Valley PACE Ceres Whitmore)

The Provider Relations Specialist will serve as a key liaison between the organization and healthcare providers within the PACE (Program of All-Inclusive Care for the Elderly) model. This role is responsible for fostering and maintaining strong positive relationships with providers ensuring seamless care coordination and supporting the organizations mission to deliver high- quality integrated healthcare services for seniors.

Located at Central Valley PACE Ceres CA

Schedule is Monday Friday working from 8:00am 5:00pm

Compensation: $25.87 $27.16 an hour

Essential Duties and Responsibilities

• Serve as the main point of contact for contracted healthcare providers including physicians specialists and other service providers.
• Foster strong long-term relationships with network providers to ensure satisfaction and high-quality care delivery for PACE participants.
• Regularly assess provider performance address concerns and collaborate to resolve any issues or barriers to care.
• Educate providers about the PACE model program goals and participant needs ensuring a shared understanding of the service delivery model.
• Conduct regular training sessions to ensure providers are informed of PACE policies procedures and best practices.
• Keep providers updated on any changes to regulations reimbursement practices and organizational guidelines.
• Assist in the development negotiation and execution of provider contracts ensuring terms align with the PACE models objectives and regulatory requirements.
• Monitor provider compliance with contract terms and letter of agreement (LOA).
• Support the contract renewal process identifying opportunities for growth efficiency and improved service delivery.
• Assist with the credentialing process for all providers ensuring adherence to the organizations policies and regulatory requirements.
• Manage CAQH (Council for Affordable Quality Healthcare) provider profiles ensuring they are up-to-date and compliant with industry standards.
• Retain and organize monthly credentialing files maintaining compliance with regulatory standards and ensuring the provider network is audit-ready for CMS (Centers for Medicare & Medicaid Services) audits.
• Ensure that all credentialing documentation is complete and accurate in preparation for regular CMS audits adhering to compliance requirements and guidelines.
• Track provider performance metrics including patient outcomes satisfaction scores and service delivery timelines.
• Assist with reporting provider performance to leadership identifying areas for improvement and suggesting actionable solutions.
• Ensure accurate documentation and reporting of all provider-related activities.
• Act as a problem solver for both providers and the PACE team addressing any issues related to service delivery claims or provider concerns.
• Use critical thinking to resolve conflicts or challenges related to participant care provider performance or operational processes.

Physical Demands

• Ability to lift up to 30 pounds. Moving lifting or pushing greater than 30 pounds should be done with assistance as appropriate.
• Must be able to hear staff on the phone and those who are served in- person and speak clearly in order to communicate information to clients and staff.
• Must have vision with or without lenses that is adequate to read memos a computer screen personnel forms and clinical and administrative documents.
• Must have high manual dexterity.
• Must be able to reach above the shoulder level to work must be able to bend squat and sit stand stoop crouching reaching kneeling twisting/turning fingering and feeling.

Work Environment

• Full-time position with occasional travel to provider sites.
• Occasional evening or weekend work may be required for meetings or events.
• The position will be based in an office environment but may require visits to healthcare facilities and provider locations.
• Exposure to biohazards including infectious material and waste and any other conditions common in a health care environment.
• Subject to unpleasant odors.
• The noise level is usually quiet to moderate but may at times be noisy and crowded.

Education/Experience Requirements

Minimum Qualifications

• Valid California Drivers License acceptable driving record and vehicle insurance.
• Must have strong communication and presentation skills both oral and written analytical and team leading skills.
• Bilingual: Spanish/English preferred.
• Proficient in Microsoft Office applications; advanced Microsoft Excel experience required.
• Proven analytical ability problem solver collaborate well in a team environment and demonstrate the ability to learn quickly.

Education/Experience

• Associates degree in business administration healthcare administration or related field; or two (2) years of equivalent relevant work experience in lieu of degree.
• Familiarity with Centers for Medicare & Medicaid Services & Health Plan Management System information technology within CMS and/or HPMS is preferred.
• Minimum two (2) years progressively responsible experience with Health Plan processes Provider relations contracting compliance and reporting.
• Current BLS CPR Card certified by the American Heart Association.

Required Experience:

IC