Provider Network Operations Coordinator

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  • 19-00490
  • Full Time/Contract
  • Recruiting
  • Pasadena, CA
Job Description
Provider Network Operations Coordinator

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
  • Typing of 40-45wpm required
  • EZ-Cap Experience Highly Preferred
  • Requires minimum of 1-2 years provider relations experience
  • Considerable knowledge of Medi-Cal/Medicare Managed Care
  • Provider related experience highly desired
  • Medical terminology experience is required

$17.00/hr – $20.00/hr


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