The Provider Services Specialist has significant responsibility for implementing and maintaining contractual agreements with health care providers and institutions within state and federal regulatory requirements. Provides high-level professional customer service to the Clinicas contracted provider network, including but not limited to, physicians and ancillary providers. This position works closely with Clinicas management team to make Clinicas the "provider network of choice" among physicians, hospitals and other health care professionals.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES The Provider Services Specialist responsibilities include, but are not limited to: Coordinate and maintain strong relationships between Clinicas and its network providers Respond to general provider inquiries regarding network participation and member coordination Serves as a liaison between specialty network providers, health plans and CDCR departments in resolving issues and problems Communicate Clinicas policies/issues to physicians, hospitals and other health care professionals Manage processes to assure consistency in Clinicas contractual agreements with its provider constituency, including credentialing requirements, mandatory annual trainings and provider surveys Arranges provider education and training of contracted health care providers and office staff on managed care concepts and Clinicas policies and procedures as they apply Work with Clinicas Medical Management team to provide education and training for health care providers and office staff on Clinicas managed care requirements and effective use of provider portal Work with Provider Services staff to assure smooth and efficient operations Answer provider claims inquiries Uses automated database and tracking systems to retrieve and update information and generate reports related to provider relation activities Develop and communicate training materials designed to educate office staff Manage Provider Database in MSO software application Composes correspondence, conducts research and prepares reports as needed Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.