Provider Relations Representative – REACH ACO

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing Whole-Person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 3,500 providers including Primary Care, Specialty, Hospital System and ancillary provider partnerships. We have operated in the Arizona market for more than 10 years, and are based in Chandler, Arizona. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The REACH (Realizing Equity, Access, and Community Health) ACO (Accountable Care Organization) Provider Relations Representative is critical to the overall success of the REACH ACO Program. New and established health care partners value great service and maintenance throughout the term of their agreement. Service includes consistent telephonic, face-to-face and written communication and interaction in order to establish and retain positive and successful relationships with the provider network.

POSITION DUTIES & RESPONSIBILITES

• Assist with investigating and resolving administrative issues and concerns between REACH ACO, provider networks and CMS.
• Develops and maintains provider relationships and serves as primary resource for internal staff and provider network.
• Maintains a regular schedule of physician office visits to ensure open lines of communication between REACH ACO and the REACH ACO provider network.
• Ensures all providers receive timely and accurate information regarding organization initiatives, services, programs, policies and procedures and quality measures.
• Ensures that Program Administration are informed of REACH participant/provider issues/concerns and supports Program Administration by providing timely communication and resolution.
• Coordinates in-office support including, but not limited to: written and oral communications with providers, monthly preparation and distribution of packets as applicable.
• Receive and respond to incoming phone calls, text messages and emails.
• Verification of provider effective dates, termination dates and demographic information; Monitor and track provider beneficiary alignment.
• Assists Manager of Provider Relations to develop tools and resources for network providers to meet performance initiative.
• Works with the Manager of Provider Relations to communicate and interact effectively with REACH participants/providers and other contracted services through coordination, attendance and presenting at regular provider meetings.
• Ensures Provider Relations department goals are achieved as assigned, improve quality and business processes for assigned network responsibility.
• Performs regular audits of printed and online REACH ACO provider directory.
• Manages qHMO, EZNet and other AZPC systems user accessibility for the provider network as appropriate.
• Assists with marketing REACH ACO by attending and participating in Program events.
• Support and coordinate the HCC program within the REACH participant provider network by assisting with ICD and CPT coding for coding/billing as assigned.
• Prepare and review statistical data for Program initiatives.
• Educate/report data to REACH participant providers on a regular basis by meeting with providers and staff as appropriate.
• Maintain a structured process for tracking and trending Program Initiatives including:
  • Tracking provider network progress on HCC Coding Validation program.
  • Coordinate with HCC Departments on further trainings.
  • Tracking Quality Measures.
  • Care Coordination Program.
  • REACH ACO Referral Programs
  • Access to Care Program
• Maintains details and accurate provider contact notes.
• Significant travel in your personal vehicle to local provider offices and events.
• Special projects and other duties as assigned by management.

EDUCATION, TRAINING AND EXPERIENCE

• Associates degree of relevant equivalent experience.
• Prior experience in Network Contracting with physicians.
• Preferred knowledge of CPT, ICD, HCPCS, HCC coding; training available for the right candidate
• Knowledge of HMO, PPO, Medicare Risk and Indemnity products preferred.
• Knowledge of qHMO, EzCap and NextGen preferred
• Firm understanding of the Medical FFS healthcare delivery system.
• Must be able to interact with providers in a professional manner with a strong commitment to positively representing the company.
• Excellent written and verbal communication with an outgoing personality, relationship oriented and attention to detail.
• Ability to maintain confidentiality.
• Ability to multi-task and prioritize in a high stress environment and make decisions or solve problems by using logic identifying key facts, explore alternatives and propose quality solutions.
• Ability to find, gather and collect information or data.
• Proficient in office equipment (computers, printers, etc.) and MS Office programs (Word, Excel, PowerPoint and Access).
• Current unrestricted Arizona Driver’s license, reliable transportation and proof of insurance required.

*This is a hybrid position, effective after first 90 days of mandatory in-office training*