Provider Network Operations Coord

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  • 18-00254
  • Full Time/Contract
  • Provider Relations
  • Pasadena, CA
Job Description
CLIENT COMPANY OVERVIEW.
Our client is an innovative network of providers delivering innovative and quality care to patients from Northern to Southern California.

JOB TITLE
PNO Coordinator
(Provider Network Operations)

JOB SUMMARY
Responsible for maintaining Contracting/Provider database system. Assist in the servicing of participating provider throughout the service area.

JOB DUTIES

  • 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.

QUALIFICATIONS

  • 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

  • Full-Time/Contract/Non-Exempt
  • $14.00/hr – $17.00/hr

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