Provider Network Specialist jobs in El Monte, 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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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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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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Compliance Special Investigator & Auditor
  • HERITAGE PROVIDER NETWORK
  • Northridge, CA FULL_TIME
  • The Compliance Special Investigator & Auditor reports to the Director of Compliance & Oversight (and SVP of Compliance-Compliance Officer). This position staffs and services the Compliance Department’...
  • 20 Days Ago

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LVN
  • HERITAGE PROVIDER NETWORK
  • Palmdale, CA FULL_TIME
  • ROUTINE: Adhere to all policies and procedures as outlined by HSMG management team. Communicate verbally and in writing through proper channels. Adhere to all Compliance Regulations including, HIPAA, ...
  • 21 Days Ago

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Outpatient Renal Case Manager
  • HERITAGE PROVIDER NETWORK, INC.
  • Northridge, CA FULL_TIME
  • We are looking for an Outpatient Renal Case Manager RN to join our team. The Outpatient Case Manager RN is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and ...
  • Just Posted

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0 Provider Network Specialist jobs found in El Monte, CA area

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Network Engineer
  • The Intersect Group
  • Torrance, CA
  • Position: Network Engineer Salary: 130-145K Location: Torrance, CA MUST HAVE ACTIVE NETWORK CERTIFICATION Description: Y...
  • 3/28/2024 12:00:00 AM

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Network Engineer
  • Heritage Provider Network
  • Northridge, CA
  • Job Description Position Summary: The Network Engineer will be a proactive customer-focused advocate and a strategist wi...
  • 3/28/2024 12:00:00 AM

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Sr Network Engineer
  • MetroSys
  • Irvine, CA
  • Responsibilities: Lead the design, implementation, and maintenance of complex network solutions utilizing Cisco, Juniper...
  • 3/28/2024 12:00:00 AM

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Network Engineer
  • The Intersect Group
  • Santa Ana, CA
  • Job Title: Network Engineer Schedule: Monday-Friday 8am-5pm Duration: 6-month contract, possibility of extension or conv...
  • 3/26/2024 12:00:00 AM

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Network Engineer
  • M-Theory Group
  • Los Angeles, CA
  • Level 1 IT Support Technician Join our team of IT professionals and provide technical support to our clients. Job Descri...
  • 3/25/2024 12:00:00 AM

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Lead Network Engineer
  • Northrop Grumman
  • Palmdale, CA
  • Put your skills to the test by pushing the boundaries of what’s possible. From global defense to sustainment and moderni...
  • 3/25/2024 12:00:00 AM

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Network Engineer
  • The Intersect Group
  • Torrance, CA
  • Job Title: Network Engineer Schedule: HYBRID 3 days on-site, 2 days remote: Monday-Friday 8am-5pm Duration: Full-time op...
  • 3/24/2024 12:00:00 AM

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Network Engineer
  • New-Indy Containerboard LLC
  • Ontario, CA
  • Position Title: Network Engineer Role Summary: The Network Engineer is responsible to ensure the stability and integrity...
  • 3/24/2024 12:00:00 AM

El Monte /ɛl ˈmɒntiː/ is a residential, industrial, and commercial city in Los Angeles County, California, the United States. The city lies in the San Gabriel Valley east of the city of Los Angeles. El Monte's slogan is "Welcome to Friendly El Monte" and historically is known as "The End of the Santa Fe Trail". As of the 2010 census, the city had a total population of 113,475, down from 115,965 at the 2000 census. As of 2010, El Monte was the 51st largest city in California. El Monte is located at 34°4′24″N 118°1′39″W / 34.07333°N 118.02750°W / 34.07333; -118.02750 (34.073276, -118.027491...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$65,965 to $98,648
El Monte, California area prices
were up 3.2% 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