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Provider Network Specialist

Alhambra Urgent Care
3.3 out of 5
Alhambra, CA
$25 - $30 an hour - Full-time
Pay in top 20% for this fieldCompared to similar jobs on Indeed

Location

Alhambra, CA

Benefits
Pulled from the full job description

  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Full job description

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