Provider Relations Representative

Sutter Connect provides health care management and administration services, including billing and accounts receivable and managed care administration, for provider groups, facilities and payers. Established in January 1999 as a Sutter Health affiliate, Sutter Connect has grown to be a leading health care management and administration services company providing services not only to Sutter affiliated groups but to other organizations as well.Sutter Connect draws upon our experienced team, sophisticated technology and processes, and high service standards to provide the best quality services and value to our clients.Sutter Connect is an Administrative Services Organization providing billing, accounts receivable and managed care administration services to many Sutter Health affiliated organizations and other organizations across Northern California.  The Provider Relations Representative is responsible for developing and maintaining a supportive and educational relationship between the Client, the Client's contracted physician network, and Sutter Connect.  This position is responsible for periodic scheduled visits to Primary Care and Specialty Physicians' offices.  In conjunction with the Client Service Coordinators, this position identifies, responds to, and resolves physician issues related to contracting issues, claims problems, and coordinates solutions with Sutter Connect departments residing in Sacramento such as eligibility, claims processing, customer service, and IT in conjunction with the local case management department.  The position will work with Health Plans' Provider Relations to support management and lead or assist in development of provider network communications related to industry changes and expansion of network initiatives.  Acts as an information resource to Sutter Connect and administrative staff in order to ensure quality customer service.  In addition, this position will interact with the Client's Marketing consulting firm to participate in a variety of Client marketing activities, including but not limited to coordination of development and distribution of Client marketing materials, participation in certain marketing events and initiatives that support the Client's managed care membership growth. Requires a Bachelor's Degree in Healthcare Administration or related field or equivalent combination of experience and education.  Requires 5 years of experience in managed care billing, claims processing, and capitation reconciliation.  IDX experience is a plus.  Healthcare provider relations and physician service industry experience is strongly preferred.  Incumbent must possess a strong knowledge of the managed healthcare industry; knowledge of IPA regulations is strongly preferred.  Hands on experience with managed care encounter submission, capitation reconciliation, and claims reimbursement processing is preferred. Experience with interacting with physicians and office staff on a one-on-one basis is required.  The ideal candidate will possess excellent ability to communicate professionally with client's physicians, staff and healthcare business executives, conduct presentations and instructional workshops to individuals and groups and analyze, problem solve, and report results in a professional manner.