Provider Service Representative I job vacancy in Health Plan of San Joaquin – Jobs in California

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We got a new job details in Health Plan of San Joaquin & they are Hiring Candidates for Provider Service Representative I

Job Details
Company Name :
Health Plan of San Joaquin
Company Location :
French Camp, CA
Job Position :
Provider Service Representative I
Job Category :
Jobs in California

Job Description :
What You Will Be Doing: Under direct supervision, responsible for the administration of provider services and related activities in assigned areas.

Monitors, researches and addresses provider and administrative inquiries, operational issues, outcomes and trends; prepares and submits findings and recommendations; primary point of contact for incoming provider calls.
Monitors, addresses and/or escalates PLOGS, faxes, incidents, service requests, mail and other incoming/outgoing correspondence; ensures necessary actions are taken to resolve related issues.
Coordinates mass membership moves, determines new providers to absorb membership, obtains approvals and facilitates changes.
Monitors and reports on member assignments, including but not limited to provider membership assignment capacity and group/individual provider affiliation.
Documents requested contract changes, provider grievances, provider demographic changes, and claims, financial and other issues; forwards to appropriate departments to be addressed.
Collaborates with internal and external stakeholders to ensure the integrity, validity and timeliness of documents and data.
Assists with preparation of New Provider Orientation presentations and packets, and other items as necessary.
Creates, maintains and publishes periodic and ad hoc reports and arranges for distribution; reviews and validates provider related reports.
Develops and maintains materials and other documents; distributes and communicates to stakeholders in a timely and effective manner.
Provides training to new employees based on established guidelines; provides coaching and training based on established standards.
Assists in the development of job aids, workflows, procedures and other documents as directed; implements in a timely and effective manner; makes recommendations for revisions.

Required Skills*What You Bring: *Required:

Produces work that is accurate and complete.
Produces the appropriate amount of work.
Actively learns through experimentation when tackling new problems, using both successes and failures to learn
Rebounds from setbacks and adversity when facing difficult situations.
Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
Basic understanding of the importance of the relationships between providers and HPSJ.
Basic knowledge of provider and/or facility contract and payment structures, and reimbursement practices, including capitation.
Basic knowledge of database concepts and terminology.
Basic knowledge of medical terminology and coding.
Interpersonal skills – interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
Basic conflict resolution skills, including the ability to use tact and diplomacy to diffuse emotional situations.
Strong oral and written communication skills, including the ability to communicate professionally and persuasively, and effectively explain complex information.
Basic public speaking and presentation skills.
Strong listening skills, with the ability to accurately receive and understand messages.
Time management and organizational skills. Uses time effectively and values time.
Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
Basic problem solving and analytical skills, including the ability to perform routine analysis and solve problems using identified data and information.
Demonstrates a commitment to HPSJ’s strategy, vision, mission and values.
Ability to work independently and as part of a team.
Basic mathematics skills.
Intermediate skills in Word and Excel.
Basic skills in Windows, Outlook and PowerPoint.
Ability to enter, manipulate, extract and generate reports from relational databases.
Ability to treat confidential information with appropriate discretion.
Ability to speak and be understood in English.


Knowledge of managed care and/or state sponsored programs and regulations.
Knowledge of network development and management strategies.
Knowledge of and ability to use report generation software such as Business Objects and/or SQL Server Reporting Service (SSRS).
Knowledge and understanding of the issues affecting providers in HPSJ’s service areas.

Required Experience*What you Have: *
Education and ExperienceRequired

Associate’s Degree; and
At least two years in a similar position; or
Equivalent combination of education and experience.


Bachelor’s Degree
Experience in managed care and/or Medi-Cal

Licensure, Certification, RegistrationRequired

Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability.

What You Will Get:

HPSJ Perks:
Competitive salary
Robust and affordable health/dental/vision (90% paid medical for employees and 100% paid dental/vision for employees) with choices in providers
Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
Two flexible spending accounts (FSAs)
Employer-Paid Term Life and AD&D Insurance
Employer-Paid Disability Insurance
Employer-Paid Life Assistance Program
Health Advocacy
Supplemental medical, legal, identity theft protection
Access to exclusive discount mall
Education and training reimbursement in addition to employer-paid elective learning courses.

A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

Job Type: Full-time

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