Provider Network Specialist jobs in Apple Valley, CA

Position Summary:

The Specialist, Network Management is responsible for providing administrative support to the Executive assigned and is also responsible for working as the internal liaison in maintaining, processing and reviewing department databases and reporting on a daily basis to assist the Network Management Department in meeting the overall network growth and development goals.

Essential Duties and Responsibilities include the following:

• Provides coordination of administrative functions for the Executive and associated department staff that is responsive to customer needs and supports fulfillment of Heritage Provider Network and Regal Medical Group mission and values.
• Creates forms and documentation, including memos, notices and drafts of Policies and Procedures as requested.
• Handles telephone calls as needed for executive assigned.
• Facilitates the scheduling of meetings for the executive or the department with providers.
• Assist in Network growth and development to include preparation of contract packets for recruitment projects.
• Responsible to work with Network Managers and providers to obtain proper signatures and documentation to effectively process newly recruited or existing providers.
• Maintaining and updating the appropriate databases and department tools with statuses.
• Coordinate receipt and processing of all provider contracts, credentialing, and correspondence.
• Responsible for timely and accurate completion of PACF's related to incoming documentation received from providers regarding changes to their demographic information in the credentialing and provider network databases.
• Responsible for initial review of all credentialing applications prior to submittal to RMG Contracts for completion and accuracy.
• Working collaboratively with Network Managers during the contracting process to ensure department goals and requirements are being met.
• Responsible for the initial submittal of provider profiles to the Health Plans and follow-up (as requested) to ensure PCP's are active in databases.
• Limited contract negotiations under the direction of the Director, Network Management and/or Vice President of Regional Operations.
• Daily interaction with regional providers.
• Ensure contract compliance and adherence to DMHC, DHS, CMS and other regulatory agencies as required by contracting HMOs.
• Internal network liaison for Database, Claims, Customer Service, Medical Management, and Provider Relation Departments.
• Perform on-site visits (as required) to physicians, physician groups, hospitals and ancillary providers.
• Oversight of database maintenance and accuracy through use of audits.
• Ensure accurate and timely data reporting requirements are being met.
• Know and follow the Employee Handbook policies and procedures.
• Maintain patient confidentiality so that HIPPAA compliance is observed at all times.
• Other duties as directed by management.

Distribution of work:

• Daily production will vary from day to day. All assigned work must be completed by the end of business day in order to maintain turnaround time compliance.

Special Projects:

• Assist with any special projects.

The pay range for this position at commencement of employment is expected to be between $24 - $26 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Education and / or Experience:

• Minimum of 2 years relevant work experience in Network Management in a managed care setting, health plan or large medical group administration.
• Knowledge of contracting principles/tools.
• Excellent verbal and written communication skills.
• Bilingual English and Vietnamese speaking preferred.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
• Must be able to travel within service area and have valid driver's license and insurance.