Irvine, California
Provider Specialist and Educator Job Opening in Irvine, California - Western Growers is a multi-faceted service organization and trade association founded in 1926 that operates a number of companies that offer a wide array of products and services to our member companies and other customers.
We operate as a large health benefit insurer ( Western Growers Assurance Trust ), a Third Party Administrator ( Pinnacle Claims Management ), our contract with Covered CA , a Pharmacy Benefit Manager ( Pinnacle RX Solutions ), an Insurance Brokerage which represents both Health and Commercial lines ( Western Insurance Services ), and finally a Financial Services company ( Western Growers Financial Services ), as well as a number of other products and services! Visit all of the companies at . Check out our video to learn more about us /UcP79T2tRxQ
We rewarded nicely with an extensive benefits package that includes a competitive compensation, a wide selection of company-paid health benefits, vacation and holiday paid time off and an excellent 401K program; including a company match of up to 3% and profit sharing up to 7%. We also provide an education reimbursement program and career path for those seeking advancement. For additional convenience there is an onsite cafeteria and to free up some of your weekend time we have on-site auto detailing and dry cleaning.
The Provider Relations Specialist is responsible for developing and maintaining strong and dependable relationships with Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management, Inc. (PCMI) Providers. You will regularly communicate organizational policies, procedures and processes, anticipate and respond to Provider educational needs and conduct ongoing Provider and office staff training.
You will also:
Visit Primary Care Physicians, Specialists, Behavioral Health Providers and Dental Providers on a periodic basis, focusing visits strategically under the direction of the Manager of Provider Operations on high volume Providers and in alignment with strategic priorities.
Conduct in-person and web-based new Provider training along with continuous training and education to Providers and office staff.
Act as a Provider Advocate and liaison between Providers and the organization.
Lead investigation and resolution of reported Provider Directory inaccuracies.
Essentials:
Three or more year?s direct experience in a healthcare network development, account management, Provider services and/or three years of experience with Healthcare/Health insurance customer service.
Possess knowledge for medical Provider relations and operations.
Knowledge of Provider fee schedule developments in DRG, CPT, CDT, RBRVS and HCPCS.
Advanced computer software skills in Microsoft Office (Microsoft Word and Excel, Access preferred), database management and skilled data input;
Ability to travel to locations throughout the US (mainly California and Arizona) approximately 30% travel time.
Effective project management skills and the ability to manage multiple projects at one time.
Verifiable, clean DMV Record and the ability to travel to locations throughout the US (mainly California and Arizona).
Job Type: Full-time
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