Provider Service Representative

Job Summary
eKlotho is a healthcare technology company focused on finding innovative ways to ensure regulatory compliance, customer services, provider experience, and measurable outcomes in the healthcare industry. Through our ever-evolving data analytics platform, we strive to improve overall medical spending, HEDIS, and STAR measures through a collaborative effort of education, reporting and workflow management. Come be part of the team that helps to improve quality of care, reduce administrative burden, and achieve greatness through creative thinking and educated calculated risks. Be the change in healthcare everyone talks about, but few people achieve. We value our team’s opinions and new ways of getting the job done and are looking for self-starters with fresh ideas, ready to help pave the way to a better tomorrow.

Duties

• · This dynamic role supports the performance and growth objectives of the respective IPAs assigned to the incumbent by engaging with various Health Plans, network Primary Care Providers, Specialists and Members.
• · Develop collaborative relations with key stakeholders, IPAs, Health Plans, and Providers offices including but not limited to Providers, office staff, billing offices to improve performance benchmarks and promote growth.
• · Conduct initial Provider orientations, education and training via in person, webinar and/or through phone calls.
• · Assist with the onboarding and implementation of new clients
• · Perform annual Health Plan compliance requirements with various offices.
• · Dissemination of reports to Physician offices as well as running comparison reports to promote performance improvements and growth.
• · Maintain and update Provider Profiles and data in the system to ensure accurate Provider Rosters for Directories, audits, and network gap analysis.
• · Assist with any access to care issues and attempt to mitigate issues through careful review of membership and network assessments.
• · Understand day-to-day managed care operations, Risk Adjustment and HEDIS measures.
• · Communicate & interact with Health Plan Representatives and attend JOC
• · Collect and track materials, documents and information such as AWEs, Credentialing materials, Attestations, Portal requests.
• · Send out mailings to Providers quarterly to ensure accuracy of network for Directory and Rosters
• · Be the “one touch resolution” for Provider and Member inquiries related to but not limited to Utilization Management, Claims, Eligibility, Contracting, and Directory validation for assigned IPA(s).
• · Utilize and work to improve database tracking and dashboard reports
• · Obtain, track and follow up on all Credentialing documents from request to completion to ensure timely Credentialing and network growth.
• · Conduct regular meetings with IPA clients to review performance reports and area for improvements.
• · Perform Special Projects as assigned to help drive company growth and improvement.

Qualifications

• Multilingual abilities are highly preferred to support diverse provider needs particularly Korean, Vietnamese, and Chinese.
• Prior experience in a medical office or healthcare setting is advantageous
• Strong understanding of medical terminology and healthcare workflows
• Excellent communication skills in English; bilingual skills are a plus
• Proficient computer skills including data entry, electronic health records (EHR) systems preferred, and Microsoft Office suite
• Demonstrated customer service expertise with professional phone etiquette
• Ability to analyze information quickly and accurately while managing multiple tasks effectively
• Relationship building, team player and creative problem solver
• Be a self-starter, solution driven, organized individual who is able to prioritize effectively on their own.
• 50% Travel by car
• Maintain a reliable means of transportation and valid driver’s license/auto insurance.

Pay: $24.25 - $50.00 per hour

Benefits:

• Flexible schedule

Work Location: Hybrid remote in Santa Ana, CA 92705