Provider Network Specialist jobs in California

Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Contract Configuration Specialist
  • HERITAGE PROVIDER NETWORK
  • Northridge, CA FULL_TIME
  • Position Summary:

     

    Provides support in the ongoing maintenance and configuration of Regal Medical Group systems, including but not limited to the data entry of Contracting Database, Providers, Vendors, Fee schedules, Capitation Configuration.  Performs system maintenance functions in a manner that is responsive to customer needs and support Regal initiatives.

     

    Essential Duties and Responsibilities include the following::

    • Adheres to Data integrity policies for all system configurations.
    • Responsible for the accurate and timely completion of tasks assigned.
    • Performs random audits as required to support policies and procedures for data integrity.
    • Communicates with management and makes recommendations to improve processes.
    • Ensure all systems within their area of responsibility are reliable, responsive and support to the needs of the Medical Group networks.
    • Maintains a customer satisfaction focused, service mentality to strengthen and build relationships with Heritage Provider Network and all Medical Groups under HPN.
    • Attends administrative meetings as requested.
    • Process a minimum of 60 provider adds daily.
    • Performs other duties as necessary.

     

    PRIMARY DAILY FUNCTION

     

    MORNING

    • Generate (PCF) Provider Can’t Find report at 8:10 AM sorting by highest lag days.
      • High lag Days -Send excel file via email to claims managers and cc: data management directors and managers listing high lag day claims.
        • Analyst must turnaround before the afternoon reports are generated.
      • Outstanding PCF’s - Send excel file via email to data management directors and managers with one worksheet listing outstanding PCF claims and second. worksheet pivoting a summarized list of claims by Date Received.
    • Generate DM Notes.xls by 8:10 AM
      • Archive worksheet - Send excel file via email to claims managers and CC: data management directors and managers.
      • Rejected worksheet - Send excel file via email to claims managers and CC: data management directors and managers.

     

    Emails must go out by 8:15 AM

     

     AFTERNOON

    • Generate a batch file of high lag day PCF’s and run the file through Symkey between 12:00 – 12:30 pm.
    • Generate a batch file of PCF’s that were able to be mapped in the morning and run the file through Symkey between 12-12:30 pm.
    • Generate a batch file claims that need a DM Notes and run the file through Symkey between 12:00 – 12:30 pm.
    • Generate PCF report after running morning Symkey batch files sorting by highest lag days by 1:15 pm.
      • High lag Days -Send excel file via email to claims managers and cc: data management directors and managers listing high lag day claims.
        • Analyst must turnaround before the afternoon reports are generated.
      • Outstanding PCF’s - Send excel file via email to data management directors and managers with one worksheet listing outstanding PCF claims and second worksheet pivoting a summarized list of claims by Date Received.

     

    Emails must go out by 1:20 PM

     

    EVENING

    • Generate a batch file of high lag day PCF’s and run the file through Symkey.
    • Generate a batch file of PCF’s that were able to be mapped in the morning and run the file through Symkey.

     

    Start Symkey jobs by 4:30 PM

     

    • All other duties as directed by management.

     

    The pay range for this position at commencement of employment is expected to be between  $20 - $25 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

    Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

  • Just Posted

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Network Engineer
  • HERITAGE PROVIDER NETWORK
  • Northridge, CA FULL_TIME
  • Position Summary: The Network Engineer will be a proactive customer-focused advocate and a strategist with meaningful experience across multiple technology areas. They will provide enterprise level ne...
  • 8 Days Ago

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Telehealth Provider (All Specialties)
  • Maven Clinic 1099 Provider Network
  • San Francisco, CA FULL_TIME
  • Maven is looking for mission-driven, empathetic practitioners to support our members through virtual care services. As a Maven provider, you will have the opportunity to meet with members across the U...
  • 15 Days Ago

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Network Specialist, Provider Network (San Diego)
  • REGAL MEDICAL GROUP, INC
  • San Bernardino, CA FULL_TIME
  • 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 mainta...
  • 7 Days Ago

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Patient Services Representative
  • HERITAGE PROVIDER NETWORK
  • Thousand Oaks, CA FULL_TIME
  • Position Summary: Responsible for greeting patients, collection of payments, insurance eligibility verification, delivering excellent customer service, answering phone calls, addressing patient questi...
  • 19 Days Ago

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Inpatient Case Manager RN / LVN -L.A. Part time
  • HERITAGE PROVIDER NETWORK, INC.
  • Northridge, CA PART_TIME
  • The Inpatient Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. Assesses a...
  • 20 Days Ago

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Network Engineer/ Sr. Network Engineer/ Cloud Network Engineer/ Network Architect
  • SoftStandard Solutions
  • Employment Type: W2-Contract (Under SoftStandard Solutions Payroll) Rate: Post Screening, it will be decided. Location: ...
  • 3/25/2024 12:00:00 AM

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Provider Network Specialist-Hearing
  • NationsBenefits, LLC
  • Fort Lauderdale, FL
  • At NationsBenefits, we are committed to helping health plan members achieve a better quality of life through supplementa...
  • 3/25/2024 12:00:00 AM

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Network Engineer
  • HRUCKUS
  • Martinsburg, WV
  • Veteran Owned Firm Seeking a Network Engineer for Onsite Assignment in Martinsburg, WV My name is Stephen Hrutka and I a...
  • 3/25/2024 12:00:00 AM

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Network Engineer
  • Booz Allen Hamilton
  • Miami, FL
  • A well-designed and secure network is critical to moving data and enabling DoD to achieve its mission, but how can an or...
  • 3/24/2024 12:00:00 AM

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Network Engineer
  • Leidos
  • Albuquerque, NM
  • Description Leidos is seeking a mid-level Network Engineer to join our team. This is an excellent opportunity for someon...
  • 3/20/2024 12:00:00 AM

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Network Engineer
  • Leidos
  • Annapolis Junction, MD
  • Description Leidos is looking for a Mid-Senior Level Network Engineer to join a high performing agile team using the Sca...
  • 3/13/2024 12:00:00 AM

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Network Engineer
  • Leidos
  • Fort Meade, MD
  • Description Are you ready to make an impact and join a creative, forward-thinking team? We’re looking for innovators and...
  • 3/7/2024 12:00:00 AM

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Network Engineer
  • Leidos
  • Laurel, MD
  • Description Provides assistance in all aspects of network management from network design through implementation, mainten...
  • 2/6/2024 12:00:00 AM

California is a state in the Pacific Region of the United States. With 39.6 million residents, California is the most populous U.S. state and the third-largest by area. The state capital is Sacramento. The Greater Los Angeles Area and the San Francisco Bay Area are the nation's second and fifth most populous urban regions, with 18.7 million and 9.7 million residents respectively. Los Angeles is California's most populous city, and the country's second most populous, after New York City. California also has the nation's most populous county, Los Angeles County, and its largest county by area, S...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$64,877 to $97,021

Provider Network Specialist in Anderson, IN
Creates, maintains, and ensures the integrity of the provider data in DHP’s multiple claims payments systems and provider interface programs.
January 07, 2020
Provider Network Specialist in Tucson, AZ
Identifies and works with the provider to address education needs relative to DHP’s new product lines/expansions, utilization management, claims submission, and back-end issues resolution requirements of each assigned provider’s contract.
January 12, 2020
The Provider Network Specialist will work closely with all facets of the business, primarily with Care Management, Claims and Business Development.
January 08, 2020
Provider Network Specialist in Oakland, CA
Build and maintain a successful working relationship with Integra Managed Care and network providers.
December 03, 2019