- Full Time/Contract
- Provider Relations
- Pasadena, CA
Our client is an innovative network of providers delivering innovative and quality care to patients from Northern to Southern California.
(Provider Network Operations)
Responsible for maintaining Contracting/Provider database system. Assist in the servicing of participating provider throughout the service area.
- Assist on project to reconcile no less than 100% of the Provider Network Operations Specialist/PCP Database with the actual contracts on file identifying discrepancies.
- Assist on development of an Access driven Provider Database for contracted Ancillary, PCPs & Specialists for the generation of various reports.
- Prepares general letters to correspond with to all interested and/or existing providers
- Submits all letters of intent to Director of Network Operations
- Support in the distribution of contract package to ancillary, specialist, PCP, hospitals providers
- Maintain a daily working relationship with Credentialing, Member Services, Quality and Utilization Management of provider matters, including Credentialing concerns, closed panel to new Medi-Cal patients, site surveys/due diligence schedule and submitting updates ancillary/specialist provider list.
- Responsible for termination provider affiliation, transferring patients to a new provider and determining a new effective date for providers
- Responsible for obtaining provider IDs from the Health Plan
- Assist department in completing Letter of Agreement
- Creates and maintains web portal logins
- Answer all provider inquires including how to obtain contract, financial affiliation, and pharmacy network information
- Maintains a file on all returned contracts that are submitted to Credentialing Department
- Develops a database of all contracted ancillary, specialist, PCPs and IPA, hospital and medical groups
- Assists Provider Network Administrators and/or Network Operations Representative on general provider inquiries
- Performs related to duties as assigned by the Manager of Provider Relations and Contracting and/or Director of Network Operations
- Performs other duties as may be assigned.
- High School Diploma or equivalent required
- Requires minimum of 2 years of related work experience.
- Considerable knowledge of Medi-Cal/Medicare Managed Care
- Provider related experience highly desired
- Medical terminology experience is required
POSITION CLASSIFICATION & COMPENSATION
- $14.00/hr – $17.00/hr