TITLE
Provider Engagement Coordinator
POSITION SUMMARY
Reports to Director, Provider Engagement. Individual is responsible for supporting the Provider Engagement Department in all aspects of operating IPA Regional Networks, including communication with client leadership, physicians, resolving physician grievances, and interface with AMM departments to satisfy the operational needs of the client. The position is also responsible for Provider support including facilitating IPA physician quality improvement program.
RESPONSIBILITIES-DUTIES
Schedules and assists in the preparation of Regional Client meetings, which may include QA/UR Committee meetings, Credentialing Committee meetings, and Marketing events. These Regional Network meetings/events will likely occur after-hours and off-site. May keep minutes of meetings and maintains action items and monitors follow-up.
Assist in providing ad hoc reports and other projects as assigned or required.
Assist to ensure compliance with all applicable state and federal guidelines and laws, and all health plan directives.
Work closely with Administration Manager to assure that all Regional Network services are performed with the highest quality outcomes. Have a working knowledge, understanding and assist with the items below:
Strategic planning recommendations that achieve IPA and Regional Network goals.
Utilization of health care services and overall quality of care.
Cash transactions, funding and disbursements, including payments from agencies, health plans and capitation and claims payments to physicians and other providers.
Provider office visits, HCC/STARs initiatives, and other provider issues.
Electronic Data Interchange and the reporting of data to Clients and health plans.
Grievances, appeals, and other reimbursement issues.
Claims reimbursement issues and provider trending.
Initiation and execution of all provider and ancillary agreements. Health plan contract and matrix of responsibility requirements
All marketing events throughout the year and maintain relationship with broker partners.
EDUCATION & EXPERIENCE REQUIREMENTS
- Bachelor or Master’s degree in Health Care Administration or Public Health Administration from an accredited university.
- Ability to manage all aspects of business operations, and effectively various projects within time constraints.
- Attention to detail and take ownership of assigned tasks.
- Must be computer literate and knowledgeable in all Microsoft Office products.
- Effectively interface and successfully cultivate relationships with internal staff, and various business partners; including health plans, hospitals, and health care providers.
- Demonstrated communication, interpersonal, and time management skills. Must be able to make presentations, conduct formal meetings, write business letters and effectively use email to communicate complex ideas.
· Valid driver’s license and/or dependable transportation to work off and on-site is necessary.
- Two years’ experience in IPA or Provider Network administration or comparable managed health care experience preferred.
· Knowledge of health plan managed care agreements and physician and provider agreements preferred.
· Understanding of EMR systems, and benefits management software preferred.
AAP/EEO Statement
It is the policy of Advanced Medical Management to provide equal opportunity for all applicants and employees. The Company does not unlawfully discriminate on the basis of race, creed, color, religion, sex sexual orientation, gender, gender identity, national origin, ancestry, age, medical condition or genetic characteristic, physical or mental disability, family care or medical leave status, military status, pregnancy, marital or domestic partner status, veteran status, or any other status protected by state or federal law.
Job Type: Full-time
Pay: $65,000.00 - $75,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Ability to Relocate:
- Suite 504 Los Angeles, CA 90020: Relocate before starting work (Required)
Work Location: In person