Provide Services Representative

📋 Description

• Provide provider orientations and ongoing training for staff and Providers.
• Maintain logs of Provider visits to ensure NCQA, DHCS and CMS compliance.
• Act as liaison between providers and client departments to resolve concerns.
• Monitor utilization reports, report cards, quality data and CRM cases.
• Investigate Provider grievances.
• Communicate with IPA staff about Provider issues and changes to resolve cases.

🎯 Requirements

• California Driver's license and high school diploma.
• 3+ years of experience with managed care; knowledge of Medical Group, IPA and HMO operations.
• Extensive customer service experience.
• Well versed in Microsoft Word, Excel and Access.
• Excellent written and verbal communication skills.