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Provider Relations Specialist III

Primary Location Pasadena, California Schedule Full-time Shift Day Salary $81100 - $104830 / year
Job Number 1359125 Date posted 05/28/2025
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Job Summary:

In addition to the responsibilities listed below, this position is also responsible for aiding the planning and development of provider satisfaction strategies to improve network relationships and enhance provider engagement; supporting the development of provider relations programs to facilitate effective provider communications and problem resolution; and creating and distributing standard media materials (e.g., articles and newsletters) and publications to providers independently; ensuring providers adhere to regulatory and contractual requirements; escalating standard and nonstandard compliance issues to appropriate parties; gathering materials to support organizational responses to regulatory audits; and beginning to deliver provider education and/or onboarding.

Essential Responsibilities:

  • Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
  • Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
  • Supports continuous improvement efforts by: organizing provider, claims, and contracting data to assist the team in identifying and/or consulting on continuous improvement opportunities across the contract ecosystem (e.g., identifying business and operational disparities between organizational and provider expectations, constraints, and risks to accessible care, building and maintaining relationships); engaging in the implementation of process improvement initiatives to aid providers and business goals;  and may also include supporting standard and non-standard analyses of provider and market data to develop recommendations for improvement initiatives.
  • Ensures contract commitments are met by: organizing provider data in appropriate data platforms and supporting the consultation of provider compliance; documenting provider activities and/or supporting the collaboration with alternate stakeholders to ensure compliance with contract terms and conditions; and following guidelines to ensure provider compliance with state and federal regulations as well as KP policies and procedures.
  • Supports contract strategy development by: executing tasks to support strategies that improve access to patient care while managing outside service costs, with minimal supervision; collaborating with team members to provide consultation on local service delivery planning to aid in the achievement of provider priorities and strategies; engaging in collaborative cross-functional workgroups and/or executing on strategies to meet the unique needs of diverse stakeholders; and participating in and/or beginning to conduct peer training for new hires and contingent workers (e.g., establishing contract language, determining payment rate parameters, defining workflow and business processes, and ensuring cross-training across all service lines).
  • Supports the growth of the Provider Network by: researching and evaluating potential partners/alliances for assigned service area to fill service gaps or decrease costs in current service offerings; developing trusting relationships with providers to understand their role in the external network; serving as a liaison between providers and KP by completing communication tasks independently (e.g., contract compliance such as access, availability, referral operations, and/or supporting member complaints); and supporting provider site visits, daily interactions, and ad hoc meetings by organizing components of itineraries and agendas, gathering credentialing materials, and/or supporting the initiation of this process.
  • Contributes to provider satisfaction by: using comprehensive foundational knowledge of provider/contract operations to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, other operational issues, and/or directories; contributing to tasks to ensure requests for information, questions, and problems are identified, documented, and addressed in a timely manner; and creating training materials to aid provider education and orientation on health plan systems, processes, and/or credentialing.
Minimum Qualifications:

  • High School Diploma or GED AND five (5) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field.

Additional Requirements:

  • Knowledge, Skills, and Abilities (KSAs): Written Communication; Compliance Management; Interpersonal Skills; Time Management; Quality Assurance Process; Computer Literacy; Trend Analysis; Business Relationship Management; Presentation Skills; Health Care Reimbursement
Preferred Qualifications:
  • One (1) year of experience working with Microsoft Excel, including working with formulas and developing integrated workbooks.
  • Two (2) years of experience with industry standard claims coding and submission processes.
Primary Location: California,Pasadena,Walnut Center - Regional Offices Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:30 AM Working Hours End: 05:30 PM Job Schedule: Full-time Job Type: Standard Worker Location: Flexible Employee Status: Regular Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee Job Level: Individual Contributor Department: Regional Offices - Pasadena - Rgnl Mg Admn-Contracting - 0806 Pay Range: $81100 - $104830 / year Travel: Yes, 5 % of the Time

Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

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