Provider Network Specialist jobs in Fullerton, CA

Commonwealth Care Alliance (CCA) is thrilled once again to host its Summer Internship Program for clinical and non-clinical departments!The Internship Program is open to undergraduate and graduate students from across the country. CCA Internships are a valuable way for students to obtain real-world experience, gain exposure to a specific field, build their network for the future, and support our members and communities. This program is a great way for CCA to attract and develop exceptional talent as we continue to grow.

This role will report to the Sr. Director of Network Operations and be responsible for various network operations administrative functions. The Network Specialist is responsible for the coordination, administrative, technical, and compliance duties, and ongoing maintenance for all plan providers, medical groups, and Independent Physician Associations (IPAs), hospitals and/or ancillary providers.

The Network Specialist will also be responsible for initial intake and assessment for both incoming routine and complex issues for all participating providers, medical groups, and IPAs, and for various activities related to provider data management and regulatory compliance.

• Administrative communication with CCA care providers, medical groups, and IPAs
• Data Management and entry activities, including:
  • Initial intake and assessment for both incoming routine and complex issues for all participating providers, medical groups, and IPAs, and for various activities related to provider data management and regulatory compliance.
  • Maintain provider rosters, including all direct contract and IPA delegated rosters
  • Submission of data adds, terms, and changes through various data warehouse systems for network inclusion.
  • Perform quality review and reconciliation of provider data, which includes core system configuration and internal provider database files
  • Assist with provider network validations and directory reviews
  • Provide Health Plan updates as necessary to all participating providers, PPGs, and IPAs via phone, fax, email, or other approved form of communication
• Responsible for answering and responding to calls, emails, and all other requests in order to resolve inquiries and issues by identifying the topic and type of assistance needed for plan participating providers, PPGs, and IPAs
• Document provider requests accurately and clearly, and monitor open service requests to ensure timely responses and closure
• Collaborate and work with appropriate departments as needed in order to complete assigned projects and resolve provider related issues.
• Provide weekly production report to the Sr. Director of Network Operations
• Maintain health plan confidentiality and compliance with all applicable laws and regulations
• Understand and abide by all department policies and procedures including organization's Code of Conduct and Compliance programs
• Perform other duties as assigned by the Sr. Director of Network Operations

Additional Information

• Remote (Must be located in California)
• All internships will be paid standard and competitive rates for undergraduate and graduate levels ($23 and $25 per hour respectively). Internships are expected to be full-time through the duration of the program.

Required:

• Undergraduate student currently enrolled or a recent graduate within the last 2 years

OR

• Graduate student currently enrolled or a recent graduate within the last 2 years
• Data Entry
• 10-Key
• Microsoft Suite (Excel and Word)
• Ability to make decisions, take actions, and follow tasks to completion
• Ability to communicate effectively (oral and written) with multiple levels of personnel
• Self-motivated to identify operational issues and make recommendations to resolve issues
• Strong problem solving and analytical skills
• Strong organizational skills with the ability to plan, prioritize and multi-task
• Ability to work in a fast-paced environment with minimal supervision
• Ability to handle multiple projects and prioritize workflow

Desired:

• Minimum 1 year experience in a healthcare setting working administratively with care providers, or
• Minimum 1 year experience of Data Entry
• Vietnamese, Chinese, or Spanish