Full-Time Provider Services Representative (Oahu)
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Job Description
The Company:
AlohaCare is a local, non-profit health plan which provides comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. In the true spirit of Aloha, AlohaCare supports, cares and serves the health care needs of Hawaii’s residents and specializes in care for the medically underserved and medically fragile. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.
The Culture:
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.
AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare’s strong commitment to support local Hawaiian families is practiced with our employees by reinforcing a healthy work/home balance. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, monthly appreciation events, quarterly all-staff meetings and annual galas. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.
These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.
Position Summary:
Serves as a provider liaison with responsibilities including implementing strategic retention, recruitment, and educational activities to support AlohaCare’s provider network related goals. Represent AlohaCare in a highly professional manner consistent with organizational values and branding objectives. Participate in on-going identification and adaptation of processes and practices to meet organizational objectives. Gathers and reports information that strengthens AlohaCare’s ability to proactively address provider issues.
Primary Responsibilities:
Communication
- Supports department participation in organizational efforts such as open enrollment, quality initiatives, NCQA accreditation, MQD readiness, HSAG audits and other activities.
- Supports production of reports including fulfillment of state contractual requirements and organizational needs.
- Contributes to the coordination, development and execution of communication products such as surveys, directory, manual, handbook, website, newsletters and provider advisories.
- Seeks and shares industry information that informs AlohaCare of current issues in the health industry and communities we serve.
- Represent AlohaCare at external provider events including exhibit booths, conference and meetings.
Retention of Providers
- Schedules and meets with providers and/or staff in assigned territory.
- Records daily contact of visits and interactions with providers in a shared database.
- Supports implementation of strategic provider network retention efforts.
- Serves as the main point of contact for the resolution of provider issues, as needed, including internal process improvement, authorizations, complaints, benefits, contracts, fees and other issues.
Recruitment of Providers
- Coordinates activities for the proactive identification and pursuit of contracts with providers to participate in AlohaCare’s network based on department priorities.
- Identify and assists in the resolution of barriers to contracting with priority providers.
Education of Providers
- Coordinates and conducts provider educational and training activities including presentations in large and small group, one-on-one and online settings.
- Assists in the development of educational and training materials and logistical arrangements for education and training events.
Other/Secondary Responsibilities
- Implement solutions to proactively address provider network issues on Oahu.
Facilitate inter-departmental collaboration for projects, process improvement and on-going operations.
Required Competencies & Qualifications:
- High school diploma or equivalent
- Minimum of three years customer service, one year healthcare, or comparable experience
- Current valid Hawaii driver’s license and access to an insured vehicle
- Strong verbal and written communication skills, including public speaking and interpersonal interaction
- High energy level and ability to perform repetitive tasks in a fast paced work environment.
- Flexibility and adaptability to changing priorities.
- Intermediate skill using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
- Ability to think critically with strong multi-tasking skills
Preferred Competencies & Qualifications:
- Bachelor’s degree.
- Provider and/or health plan experience
- Medicaid and/or Medicare experience.
Working Conditions/Physical Demands:
- Inside working conditions.
- No environmental hazards.
- Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
- Requires occasional inter-island travel with occasional overnight stays
- Requires verbal and written communication in English
*Apply online: http://www.alohacare.org/careers/
How to Apply:
For more information, please contact Josie Gesteuyala, HR Generalist
Phone: 808.973.6339
Email: jgesteuyala@alohacare.org
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record), disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.
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