• Provider Relations Education Specialist

    Job Locations US-CA-Fairfield
    Job ID
    Provider Relations
  • Overview

    To develop provider and member educational opportunities for internal departments, external agencies, training, and materials to support PHC providers, community partners, and members. Provides hands-on support to internal team as well as to PHC providers, community partners, and members.


    • Identifies knowledge and resource gaps and works to support and educate provider, community partners, members, teammates and program partners. Develops a strategic approach towards policy change, new benefit development, and/or performance improvement.
    • Conducts customized education and training sessions.
    • Prepares and presents data interpretation and recommendations at a level understood by diverse audiences.
    • Establishes and maintains partnerships with providers and community partners via effective communication via phone, email, and in-person meetings.
    • Works closely with other departments to identify opportunities for education and process improvement.
    • Serves as liaison between programs and providers/community partners and facilitates dialogue and information exchange internally and externally.
    • Coordinates all logistics of planning and implementing training and education meetings.
    • Other duties as assigned.


    Education and Experience

    Bachelor’s degree; prior experience with managed care of health insurance environment preferred; or equivalent combination of education and experience.



    Special Skills, Licenses and Certifications

    Knowledge of business software applications. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business. Training and/or Certification in Substance Use Disorders, Behavioral Health, Community Health Work, or Social Work may be preferred. 



    Performance Based Competencies

    Excellent written and oral communication skills. Requires excellent organizational skills with the ability to prioritize assignments, maintain accurate records, and meet deadlines.



    Work Environment And Physical Demands

    When required, ability to lift, carry, or move objects weighing up to 30 lbs. Travel required, including overnight if needed.




    Additional Preferred Skills: Public Speaking, development and delivery of web-based and in-person presentations. Some travel to all 4 regional offices may be required. 

    • Have the ability to look at the big picture of claims processing and authorizations to identify educational opportunities.
    • Work and communicate with the Claims Resolution Coordinator(s) to identify and develop targeted provider education based on their research of provider billing issues.
    • Provide in-services to PHC internal staff. 
    • Review PHC website documentation for accuracy on a monthly basis.  Coordinate changes and or corrections with the appropriate departments.
    • Answer provider telephone inquiries using the ACD PR phone system.  Coordinate issues resolutions with the assigned Provider representative.  Investigate and respond to provider inquiries.
    • Participate in ad hoc workgroups and Special Projects as directed by Manager.




    All HealthPlan employees are expected to:


    • Provide the highest possible level of service to clients;
    • Promote teamwork and cooperative effort among employees;
    • Maintain safe practices; and
    • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.




    The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.




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