Provider Field Representative - San Diego Region

Summary

The Provider Field Representatives, also known as Regional Representatives serve as a critical link between providers, customers, and internal teams, ensuring effective communication, timely issue resolution, and proactive engagement. This position supports the provider community in a variety of areas including outreach, research, communications, virtual/onsite visits, as well as virtual and face-to-face training delivery.

The role combines customer inquiry management and basic process/project coordination with provider outreach and training. The role purpose is to manage inquiries, research, outreach and training from onset to completion, to enhance service quality, and Medi-Cal program compliance. This role works with providers (provider trading partners), provider associations, and directly with the client in support of the Medi-Cal program.

Your role in our mission

• Under minimal supervision, using independent judgement, respond to inquiries from clients, providers, and internal stakeholders with professionalism and accuracy. Handle claims research, billing support, and issue resolution to build trust and maintain strong relationships. Apply knowledge of policies and procedures to resolve issues and ensure adherence to program standards.
• Plan and deliver training sessions (including workshops, seminars, program specific group events)—both virtual and in-person—covering billing processes, policy updates, and program requirements. Act as a liaison between providers and internal departments to develop training material and implement initiatives that support program goals.
• Provide one on one billing support, claim research and analysis. Coordinate the flow of correspondence, ensuring clarity, accuracy, and timely responses. Maintain organized communication channels to support collaboration across teams.
• Research claim trends, analyze data, and provide actionable insights to improve processes and provider experience.
• Support schedule development, track/own progress of training and outreach deadlines. Escalate risks or delays to keep initiatives on track.

What we're looking for

• Excellent verbal and written communication, presentation, and training skills for diverse audiences (virtual and in person settings), with a focus on simplifying complex billing and policy topics
• Three or more years’ experience in the healthcare industry in insurance, provider support, IT and operations. Provider billing experience and working knowledge of CMS-1500 and UB-04 claim forms preferred
• Ability to work independently and exercise judgement. Hands-on experience with researching, resolving, educating providers on claims processing, billing, and reimbursement; Medi-Cal or Medicaid experience preferred.
• Strong analytical and organizational skills with the ability to manage multiple priorities; including basic project management capabilities for scheduling and progress tracking of training and outreach tasks.
• Willingness to travel within one or more geographic regions to support outreach and training needs.

What you should expect in this role

• Must be a resident of the state of California
• Travel required throughout one or more geographic regions to support outreach, training and other provider and account needs.
• For positions assigned to WFH, reliable high-speed internet connectivity is required.  Employees working-from-home may be required to report to the office, at times, to support meetings, special training requests or other business needs. The office is in West Sacramento.

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