Physicians Medical Group of San Jose / Excel MSO is looking for the best and brightest professionals to handle the business side of medical practice so “doctors can be doctors.” We are fortunate to have experienced unprecedented growth in the last few years – and we’re just getting started. As the largest Independent Physicians Association in Santa Clara County, not only do we partner with the most health plans, but we’re also the first, and only, Clinically Integrated Network in Silicon Valley.

We deeply trust and value our dedicated physicians and employees who provide compassionate care to our 100,000+ patients every day. If you are looking for a rewarding opportunity with an innovative, collaborative, and inspirational team, join us at PMGSJ / Excel MSO, and help us continue to be trailblazers in the transformation of health care.

We are looking for a Provider Relations Representative

Under the general guidance from the Manager, Network Operations, the Provider Relations Representative is responsible for building long-term relationships with physicians, ancillary providers and their staff in a positive and proactive manner to support their understanding and compliance with Physicians Medical Group of San Jose / EXCEL MSO contracts, policies and procedures.

Primary Responsibilities:

Coordinating provider site visits and conducts on-site trouble shooting.

Providing timely training per Physicians Medical Group of San Jose (PMGSJ)/EXCEL MSO and state requirements. Provide orientations for new providers and their staff or upon request from the office. Introduce new programs, policies or procedures to providers and their staff.

Fostering and maintaining proactive positive relations throughout the provider network by communicating with provider offices through face-to-face visits, letters, telephone calls, faxes or emails for promoting PMGS /EXCEL, sharing data and information about the providers practice, PMGSJ/EXCEL processes and other miscellaneous updates as well as for gathering information and feedback from the provider about any issues or concerns related to PMGSJ/EXCEL.

Effectively identifying, directing and or researching provider operational issues for timely resolution per PMGSJ/EXCEL and state requirements through a thorough knowledge of all areas of PMGSJ/EXCEL operations and a strong working relationship with other departments.

Assessing the composition of the existing network, the opportunities for expansion in assigned territories and the availability of services in the surrounding communities to provide a comprehensive overview and understanding of the medical community to both internal and external customers.

Reporting from the databases and other resources to provide information about the network to internal and external customers.

Assist in the creation and maintenance of department training materials.

Preparing and delivering verbal presentations in a group or one-on-one setting to PMGSJ/EXCEL network providers and their staff.

Participating in internal and external workgroups and meetings.

Performing other duties and special projects as assigned.

Required Qualifications:

• HS diploma or equivalent.
• Three years’ job experience in Provider Relations for managed care medical group or health plan.
• Managed Care experience in areas of customer service, claims payments claims resolution and/ or provider service preferred.
• Knowledge of CMS 1500 and UB 92 forms
• Knowledge of Medical Terminology and CPT Codes.

· Valid CA Clean Driving record

Special Requirements

• Excellent written and verbal communication and presentation skills and exercise sound judgement.
• Strong interpersonal, organizational, analytical and critical problem-solving skills.
• Develop and maintain strong internal and external working partnerships.
• Knowledge of Medi-Cal, Medicare and Commercial insurance.
• Ability to manage multiple tasks in a high-pressure environment.
• Ability to make decisions in the absence of detailed instructions and work independently or in a team environment.
• Knowledge of healthcare practice management systems, electronic medical records, and/or billing systems highly desirable.
• Proficient in the use of Microsoft Office products (Word, Excel, Outlook and PowerPoint).
• Requires cell phone usage for emails and phone calls.
• Valid California driver’s license, automobile registration and proof of current insurance required.

Ability to work regularly scheduled shifts within our hours of operations including the training period, where lunches and breaks are scheduled, with flexibility to adjust daily schedule.

Physical Demands

· Constant and close visual work at a desk or computer constant sitting and working at a desk

· Constant data entry using a keyboard and or mouse,

· Constant use of telephone headset

· Frequent verbal and written communication with providers, members internal staff and other business associates by telephone, correspondence or in person.

· Frequent walking and standing

· Driving to and from provider offices

· Lifting infrequent, up to 25 lbs. weight

Careers with Optum at Excel MSO.

Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.

Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

ENVIRONMENTAL CONDITIONS
General office conditions. May be exposed to moderate noise levels.

Job Type: Full-time

Job Type: Full-time

Pay: $70,000.00 - $89,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

COVID-19 considerations:
COVID-19 considerations:
Full COVID-19 vaccination is an essential requirement of this role. We will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to

Ability to commute/relocate:

• San Jose, CA 95131: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

• Provider Relations: 2 years (Preferred)
• Customer service: 3 years (Preferred)

Language:

• Vietnamese (Preferred)

Work Location: One location

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