Provider Network Specialist
Pay Range: $25.00 - 30.00
Location: Alhambra, CA area.
We seek a dynamic and detail-oriented Provider Network Specialist to join our team!
Responsibilities
- Supports contracting efforts in assigned regions for IPA business relationships
- Negotiate and draft agreements, amendments, open-ended Memorandum of Understanding (MOUs), and Patient Specific MOUs.
- Process, Load, and maintain contracts and providers in the contracting database application.
- Acts as liaison with various internal departments to facilitate and resolve claims, provider configuration, customer service, credentialing, and other related issues
- Negotiate and draft agreements and amendments outlining contractual terms as directed.
- Engage in specialty provider recruitment efforts to support network adequacy requirements.
- Present contracts and amendments for execution.
- Draft provider correspondences.
- Initiate Alerts for adds, terms, and changes to internal departments for claims and referral system updates, health plan submissions, and member outreach as needed
- Ensure agreements and providers to contracting data application with all contractual terms and linkages with MSO.
- Manage Provider Claims and Referral Inquiries.
- Negotiate MOUs for referrals to non-contracted providers and secure savings for non-contracted claims.
- Provide clarification on contractual arrangements to MSO internal departments, providers, and billing companies.
- Provides customer service to network providers and other internal departments by responding to contracting inquiries, claims questions, credentialing inquiries, and provider configuration.
- Follow up on the return of signed contracts, amendments, credentialing applications, and attestations.
- Works with the credentialing department to obtain credentialing and re-credentialing documents.
- Provides administrative support to Contract Administrator.
- Generate reports as requested and other duties as assigned.
- Track and document tasks to completion.
Qualifications:
- Requires an Associate’s degree in business, healthcare policy, public health or related field, or equivalent experience.
- A minimum of 2 years experience in Network Management, working in a managed care setting, health plan, or significant medical group administration.
- Effective project management skills, understanding of contracting administration and general healthcare reimbursement methodologies, and knowledge of financial impact analysis.
- Excellent oral/written, communication, and presentation skills, including influence abilities for internal and external discussions.
- Excellent analytical and problem-solving skills, including knowledge of financial impact analysis.
- Experienced in Microsoft Office including Word, Excel, PowerPoint, and Outlook
- Flexible team player who can also work independently.
- Courageous!
Job Type: Full-time
Pay: $25.00 - $30.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Education:
Experience:
- Network management: 2 years (Required)
- Managed care: 2 years (Required)
- Draft contracts: 2 years (Required)
Work Location: In person