Provider Network Coordinator

  • Full Time
  • Pasadena

Imperial Management Administrators Services

General Summary:

Responsible for maintaining Contracting/Provider database system. Assist in the servicing of participating provider throughout the service area.

Essential Functions and Key Responsibilities:

Assist on project to reconcile no less than 100% of the Provider Network Operations Specialist/PCP Database with the actual contracts on file identifying discrepancies.
Assist on development of an Access driven Provider Database for contracted Ancillary, PCPs & Specialists for the generation of various reports.
Prepares general letters to correspond with to all interested and/or existing providers
Submits all letters of intent to Director of Network Operations
Support in the distribution of contract package to ancillary, specialist, PCP, hospitals providers
Maintain a daily working relationship with Credentialing, Member Services, Quality and Utilization Management of provider matters, including Credentialing concerns, closed panel to new Medi-Cal patients, site surveys/due diligence schedule and submitting updates ancillary/specialist provider list.
Responsible for termination provider affiliation, transferring patients to a new provider and determining a new effective date for providers
Responsible for obtaining provider IDs from the Health Plan
Assist department in completing Letter of Agreement
Creates and maintains web portal logins
Answer all provider inquires including how to obtain contract, financial affiliation, and pharmacy network information
Maintains a file on all returned contracts that are submitted to Credentialing Department
Develops a database of all contracted ancillary, specialist, PCPs and IPA, hospital and medical groups
Assists Provider Network Administrators and/or Network Operations Representative on general provider inquiries
Performs related to duties as assigned by the Manager of Provider Relations and Contracting and/or Director of Network Operations
Performs other duties as may be assigned.
Minimum and Preferred Qualifications:

Typically, requires minimum of 2 years of related work experience.
Considerable knowledge of Medi-Cal/Medicare Managed Care
Medical terminology is needed
Education:

HS Diploma or GED is required. AA is preferred.

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