Provider Network Specialist jobs in Coachella, CA

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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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 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
    Requirements:

    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.
  • 7 Days Ago

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Inpatient Case Manager LVN/RN
  • HERITAGE PROVIDER NETWORK
  • San Bernardino, CA FULL_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...
  • 6 Days Ago

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Physician Assistant or Nurse Practitioner
  • HERITAGE PROVIDER NETWORK, INC.
  • San Bernardino, CA FULL_TIME
  • Position Summary: Provides primary health care and performs selective medical services under the direction of their Supervising Physician and Medical Director. Essential Duties and Responsibilities in...
  • 7 Days Ago

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Hospitalist (Physician Assistant or Nurse Practitioner)
  • HERITAGE PROVIDER NETWORK
  • San Bernardino, CA FULL_TIME
  • Position Summary: Provides primary health care and performs selective medical services under the direction of their Supervising Physician and Medical Director. Essential Duties and Responsibilities in...
  • 9 Days Ago

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Specialist Network
  • Rio Tinto Group
  • Boron, CA FULL_TIME
  • Specialist – Network Join our global leading business offering outstanding personal development & global career opportunities. Be part of a group that is safety driven and values inclusion – Boron, Ca...
  • 20 Days Ago

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Np or pa
  • Provider Healthcare
  • Palm Springs, CA FULL_TIME
  • Job Type Full Time Schedule M-F 8-5 Patients Per Day 16-18 Work Location Outpatient clinic Job Description A Palm Springs, California based clinic is searching for a Nurse Practitioner or Physician As...
  • Just Posted

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0 Provider Network Specialist jobs found in Coachella, CA area

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IT Help Desk Technician - AU-24-02407
  • AUTAJON GROUP
  • Corona, CA
  • We see beautiful packaging and detailed labels in every aspect of our day-to-day lives and don't think much about it. Bu...
  • 3/28/2024 12:00:00 AM

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Maintenance Electrician
  • Armtec Defense Technologies
  • Coachella, CA
  • Maintenance Electrician, Armtec Defense Technologies Armtec Defense Technologies (Armtec) is an operating unit of the Tr...
  • 3/28/2024 12:00:00 AM

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Truck Care Diesel Technician
  • Loves Travel Stops & Country Store
  • Coachella, CA
  • Req ID:430312 Address: 45-761 Dillon Rd.Coachella,CA, 92236 Welcome to Loves! Where People are the Heart of Our Success ...
  • 3/28/2024 12:00:00 AM

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Criticalist
  • VCA Animal Hospitals
  • Indio, CA
  • **VCA Valley Animal Medical Center & Emergency Hospital** is seeking a **Criticalist** to join our well-established and ...
  • 3/28/2024 12:00:00 AM

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IT Support Engineer FULL TIME Position REMOTE - Corona, CA MSP
  • Onsite Computing
  • Corona, CA
  • Job Description Job Description We are seeking an IT Support Engineer working full time in a REMOTE position to join our...
  • 3/27/2024 12:00:00 AM

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System Engineer
  • Robert Half
  • Corona, CA
  • Onsite in Corona, CA. Full time employment. No C2C We are seeking a highly motivated and results-oriented Systems Admini...
  • 3/25/2024 12:00:00 AM

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Travel CT Technologist - $2,700 per week
  • Stability Healthcare
  • Indio, CA
  • Travel Nurses, Inc. is seeking a travel CT Technologist for a travel job in Indio, California. Job Description & Require...
  • 3/25/2024 12:00:00 AM

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Quality Engineer
  • Abbott
  • Temecula, CA
  • Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-chan...
  • 3/24/2024 12:00:00 AM

Coachella (/koʊˈtʃɛlə/, /koʊ.əˈtʃɛlə/) is a city in Riverside County, California; it is the easternmost city in the region collectively known as the Coachella Valley (or the Palm Springs area). It is located 28 miles (45 km) east of Palm Springs, 80 miles (130 km) east of Riverside, and 130 miles (210 km) east of Los Angeles. Known as the "City of Eternal Sunshine", Coachella is largely a rural and agricultural community in the desert and one of the state's fastest growing cities in the late 20th century. When it first incorporated back in 1946, it had 1,000 residents, but the population was 4...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$62,440 to $93,376
Coachella, California area prices
were up 3.0% from a year ago

Provider Network Specialist in Springfield, MO
As the liaison between provider and the health plan, candidates are tasked with ensuring improved revenue generated and patient quality score.
December 16, 2019
Provider Network Specialist in Stamford, CT
Previous experience in a network development, provider recruitment or provider contracting.
December 04, 2019
Provider Network Specialist in Fort Wayne, IN
In this position, employees will be expected to perform benefits analysis and create reports on provider performance to support the needs of the analysis found.
January 18, 2020