Provider Services Representative - San Luis Obispo

We work with a vast network of dedicated and compassionate doctors, hospitals, pharmacies and other types of providers and facilities that take care of our members. We presently have over 275 Primary care providers and more than 1250 specialists that provide care to our members. They give generously of their time and expertise. We also have a very dedicated board of directors that come from within our community. They donate their time to oversee and ensure the best outcome for our members, and oversee our budget.

We provide health coverage for 1 in 4 people in Santa Barbara County, and 1 in 5 in San Luis Obispo County. We hope you will see our commitment to our community here. CenCal Health is a great place to work, and there is information about joining our team within this section. We have been in operation since 1983, and are recognized nationally as the oldest Medicaid managed care program of its kind in the country.

The primary objective of this position is to lead and facilitate the contracting, communication, and management of provider relationships in support of strategic organizational objectives.  The Provider Services Representative is responsible for developing the provider network through contract negotiations, relationship development, and ongoing service.  With direction from the Director of Provider Services, the Provider Services Representative develops provider contracting and incentive initiatives.

This position is responsible for: advocating, appealing, recruiting, contracting, educating, maintaining, and improving provider participation and satisfaction.

The position reports to the Provider Services Representative Supervisor. Primary internal contacts include all relevant personnel in CenCal Health. Primary external contacts include all health care providers, their office staff, local public agencies, community organizations, and hospitals and healthcare facilities.

• Facilitate provider recruitment, contracting and retention efforts, conduct on and off site visits, provide orientation, ongoing education and training to providers and staff; ensure contract compliance of, and access to the Provider Network for all new and existing programs; keep provider data accurate and up to date
• Advocate on behalf of the providers, investigate provider issues, prepare recommendations for resolution, compose responses, and document all communication
• Educate providers: make presentations as required; prepare materials, coordinate meetings, oversee expenditures, and evaluate effectiveness of presentations; assist in preparation of educational, promotional, and presentation materials and publications for providers and the public, and disperse those materials as appropriate; assist in publishing Provider Bulletins
• Assist with special projects, including compliance with regulatory responsibilities; make recommendations for improvement of any and all procedures and systems at CenCal Health
• When appropriate, represent the Provider Services Department on internal CenCal Health committees; analyze access barriers in relation to the provider network; assist in the creation of new features and functionality for the website, and educate staff and the provider network on all new features
• Ensure contract compliance and high-quality standards by assisting providers in all phases of the contract process
• Other duties as assigned by the Provider Services Representative Supervisor or Director of Provider Services

All your information will be kept confidential according to EEO guidelines.