Provider Network Specialist
3.
3 Alhambra, CA Alhambra, CA Full-time Full-time $25 - $30 an hour $25 - $30 an hour 11 days ago 11 days ago 11 days ago 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:
Associate (Required)
Experience:
Network management:
2 years (Required) Managed care:
2 years (Required) Draft contracts:
2 years (Required) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
3 Alhambra, CA Alhambra, CA Full-time Full-time $25 - $30 an hour $25 - $30 an hour 11 days ago 11 days ago 11 days ago 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:
Associate (Required)
Experience:
Network management:
2 years (Required) Managed care:
2 years (Required) Draft contracts:
2 years (Required) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
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