Provider Relations Specialist – IPA Network Growth

RXinsider LTD.; San Bernardino, Northern (CA, KY); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

Optum is seeking a Provider Relations Representative to act as the primary interface between Optum and physicians in the IPA network. The role supports operations, performance, education, training and troubleshooting for providers and staff.

The position requires regular travel across Riverside County and entails building relationships, monitoring performance, addressing issues, and collaborating with the growth team to drive membership and retention within the network.

Qualifications

• 2+ years health care/managed care experience.
• 2+ years provider relations/network experience.
• Intermediate claims processing and issue resolution.
• Proficiency with Microsoft Office Suite.
• Able and willing to travel 50% within assigned territory.

Responsibilities

• Serve as single-point-of-contact to the physician network and be an accountable owner, responsive to physician needs.
• Monitors performance of assigned PCPs and develops action plans for improvement with IPA leadership.
• Intervenes and escalates issues as appropriate.
• Maintains awareness of providers interested in new business opportunities with Optum IPA.
• Works with growth team to drive membership growth and retention.
• Responds promptly to provider issues and coordinates resolution.
• Builds collaborative relationships with IPA physicians and their staff.

Skills

Healthcare experience

Provider relations

Claims processing

Microsoft Office

Travel readiness

Tools

Microsoft Office Suite

Job description

Optum is seeking a Provider Relations Representative to act as the primary interface between Optum and physicians in the IPA network. The role supports operations, performance, education, training and troubleshooting for providers and staff.

The position requires regular travel across Riverside County and entails building relationships, monitoring performance, addressing issues, and collaborating with the growth team to drive membership and retention within the network.