Provider Network Specialist jobs in Pasadena, CA

Provider Network Specialist

Pay Range: $25.00 - 30.00

Location: Alhambra, CA area.

We seek a dynamic and detail-oriented Provider Network Specialist to join our team!

Responsibilities

• Supports contracting efforts in assigned regions for IPA business relationships
• Negotiate and draft agreements, amendments, open-ended Memorandum of Understanding (MOUs), and Patient Specific MOUs.
• Process, Load, and maintain contracts and providers in the contracting database application.
• Acts as liaison with various internal departments to facilitate and resolve claims, provider configuration, customer service, credentialing, and other related issues
• Negotiate and draft agreements and amendments outlining contractual terms as directed.
• Engage in specialty provider recruitment efforts to support network adequacy requirements.
• Present contracts and amendments for execution.
• Draft provider correspondences.
• Initiate Alerts for adds, terms, and changes to internal departments for claims and referral system updates, health plan submissions, and member outreach as needed
• Ensure agreements and providers to contracting data application with all contractual terms and linkages with MSO.
• Manage Provider Claims and Referral Inquiries.
• Negotiate MOUs for referrals to non-contracted providers and secure savings for non-contracted claims.
• Provide clarification on contractual arrangements to MSO internal departments, providers, and billing companies.
• Provides customer service to network providers and other internal departments by responding to contracting inquiries, claims questions, credentialing inquiries, and provider configuration.
• Follow up on the return of signed contracts, amendments, credentialing applications, and attestations.
• Works with the credentialing department to obtain credentialing and re-credentialing documents.
• Provides administrative support to Contract Administrator.
• Generate reports as requested and other duties as assigned.
• Track and document tasks to completion.

Qualifications:

• Requires an Associate’s degree in business, healthcare policy, public health or related field, or equivalent experience.
• A minimum of 2 years experience in Network Management, working in a managed care setting, health plan, or significant medical group administration.
• Effective project management skills, understanding of contracting administration and general healthcare reimbursement methodologies, and knowledge of financial impact analysis.
• Excellent oral/written, communication, and presentation skills, including influence abilities for internal and external discussions.
• Excellent analytical and problem-solving skills, including knowledge of financial impact analysis.
• Experienced in Microsoft Office including Word, Excel, PowerPoint, and Outlook
• Flexible team player who can also work independently.
• Courageous!

Job Type: Full-time

Pay: $25.00 - $30.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Associate (Required)

Experience:

• Network management: 2 years (Required)
• Managed care: 2 years (Required)
• Draft contracts: 2 years (Required)

Work Location: In person