Provider Field Representative Lead - Remote California

Summary

The Provider Field Representative Lead provides functional leadership and support to Provider Field Representatives serving California’s Medi-Cal provider community.

This role supports team escalations, provider outreach, claims research, provider billing support, and the development and delivery of virtual and in-person training. The Lead also serves as a liaison between providers, provider associations, internal departments, and the client to help ensure consistent service delivery and compliance with Medi-Cal program requirements.

Your role in our mission

• Provide functional leadership and direction to Provider Field Representatives, serving as a resource for team escalations, complex provider inquiries, billing questions, claims issues, and program requirements.
• Support provider billing activities, including one-on-one billing assistance, claims research and analysis, reimbursement questions, and resolution of provider billing issues.
• Support and help direct provider education and outreach, including workshops, seminars, program-specific events, one-on-one training, and provider association activities.
• Serve as a liaison between providers, internal departments, and the client to resolve issues and support Medi-Cal programs and initiatives.
• Apply established policies and procedures while exercising independent judgment to resolve complex provider issues, identify areas of concern, and recommend appropriate solutions or escalation.
• Contribute to shared knowledge resources, document complex issue resolution, and help ensure consistent and accurate information is provided across the team.
• Support the development and mentoring of Provider Field Representatives while identifying opportunities to improve provider service, team processes, and overall operational effectiveness.

What we're looking for

• Three or more years of business process outsourcing, consulting, systems implementation, provider relations, provider services, or related healthcare operations experience.
• Experience supporting healthcare providers with billing, claims research, billing issues, and reimbursement-related questions.
• Experience serving as a functional lead, subject matter expert, mentor, trainer, or escalation point for a team.
• Experience developing and/or delivering training to healthcare providers virtually and in person.
• Strong provider relations, analytical, problem-solving, communication, presentation, facilitation, and functional leadership skills.
• Experience working with business processes, assessing provider or client needs, and identifying opportunities for improvement.
• Medi-Cal or Medicaid experience preferred.
• Willingness and ability to travel throughout California.

What you should expect in this role

• Remote position; must reside in California.
• Travel throughout California is required to support provider training, outreach, events, and other business needs.
• Occasional overnight travel and onsite attendance may be required.
• Reliable high-speed internet connectivity is required.

This is a pipeline requisition designed to build a pool of qualified candidates for current and future opportunities as positions become available.

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