St. Joseph Health Senior Provider Relations Representative in Anaheim, California

Job Summary: Under the supervision of the Director, this position builds and fosters relationships with SJHH contracted physician/specialist offices. Key responsibilities include Physician Office In-services, continuous physician office education, provider problem resolution, development and management of network communications, and facilitation of network development.

Essential Values-Based, Leadership and Management Competencies: Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by employees in order to achieve the Mission of the St. Joseph Health System.

Dignity: Demonstrates competence in communication and interpersonal relations.

Excellence: Demonstrates competence in continuous improvement, continuous learning, accountability, and teamwork.

Service: Demonstrates competence in customer/patient focus and adaptability.

Justice: Demonstrates competence in community orientation and stewardship.

(As defined on the attached Values-Based Competency Model Form.)

Essential Functions:

• Fosters a close working relationship with assigned physician offices including communicating with provider office regarding member/provider issues. Independently researches and resolves concerns/issues for provider offices and provides accurate and timely answers. Monitors and tracks service issues and inquiries for identification and trending of education opportunities/programs to improve overall provider service and satisfaction (25%)

• Manages monthly provider visits and calendar of in-services to new and established physician offices. Interprets health plan policies and procedures and develops training tools and guidelines to train provider network to ensure compliance. Develops training programs on Point of Care Tools i.e. Ascender and Referral Management System and conducts training. Updates Provider Manual as necessary to ensure manual reflects most current information for network providers. (25%)

• Responsible for developing SJHH Network Communications and collaborating with Provider Network Operations to effectively distribute notifications. (15%)

• Collaborates with Network Development to identify providers within all specialties for recruitment. (5%)

• Conducts access survey, analyzes data and develops corrective action plans as required. Conducts necessary training as needed to ensure compliance. (10%)

• Conducts physician office meetings and other network trainings by planning, creating, and delivering presentations (10%)

• Coordinates and attends health fairs, senior events including ABCs of Medicare Meetings, employer events and other various enrollment functions to promote networks. (5%)

• Acts as a liaison with various SJHH Departments, physician offices and health plans to resolve provider issues and facilitate notifications (5%).

Additional Responsibilities:

• Keep informed of current health/managed care information.

• Training of new Provider Relations staff on Provider Relations policies and procedures.

• Performs other duties as assigned.

Age-Related Competencies: Demonstrates age appropriate communication skills for the population served.

Information Management: Treats all information and data within the scope of the position with complete confidentiality and security. Maintains all practices to protect PHI and follow HIPAA guidelines.

Risk Management: Cooperates fully in all risk management activities and investigations.

Safety Requirements: Is knowledgeable of, observes and complies with Codes of Safe Practice, safety policies and emergency procedures.

Minimum Position Qualifications:

Education: High School Diploma or equivalent required.


• Requires three (3) plus years’ experience as a Provider Relations Representative working with physicians in a Managed Care/IPA, Medical Group, Health Plan or MSO environment.

• Advanced knowledge of managed care principles and methodologies.

Computer Skills:

• Basic computer skills including Windows, Microsoft Office Word, Outlook, and Excel.


• Valid California Driver’s License for travel between St. Joseph Heritage Healthcare locations.

• Knowledge of medical terminology, medical billing, and medical office procedures.

Knowledge / Skills / Abilities:

• Strong interpersonal and organizational skills to achieve desired goals and to interact effectively with management and non-management staff and physician groups.

• Attention to detail and follow-up skills required.

• Must be able to maintain a positive attitude under changing conditions.

• Ability to seek out available resources to resolve problems.

• Must be able to make independent decisions.

• Must have a professional and mature demeanor.

• Must be able to work in a fast-paced department while handling multiple tasks, working with interruptions, and dealing effectively with confidential information.

Preferred Position Qualifications:

Education: Bachelor’s degree in Healthcare Management or related field highly desirable.

Experience: Five (5) plus years’ managed care Provider Relations experience.

Computer Skills: Advanced skills in MS Excel, Word, Access, and IDX.

Environmental Conditions: May include exposure to potentially hazardous material, infectious agents, contact with patients, public and staff.

Physical Requirements: Sitting for long periods of time, bending, reaching, stooping, kneeling, pushing/pulling, lifting/carrying up to 15 lbs., and grasping.

Additional physical requirements are defined on the attached Physical Demand Analysis.

St. Joseph Heritage Healthcare (SJHH) is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, SJHH has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values.St. Joseph Heritage Healthcare (SJHH) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Joseph Heritage Healthcare (SJHH) complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Company: Heritage Healthcare