Universal Healthcare MSO, LLC
Provider Network Management:
Provider Network Management is responsible for the management of contracting and network management activities. Provider Network Management is the primary contact between Universal
Healthcare IPA and contracted/non-contracted Providers.
Education and Experience:
- Bachelor’s Degree in Business, Healthcare or similar preferred. equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.
- 5+ years’ experience in managed healthcare administration and/or Provider Services.
- Exceptional in-depth healthcare/insurance knowledge for medical Provider relations and operations; network development, network contracting, account management, Provider services, Provider contracting.
Essential duties and responsibilities:
- Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
- Ensure regulatory and statutory compliance of Provider contracts and execute on remediation efforts.
- Acts as a Liaison between Health Plan and Universal Healthcare IPA
- Develop and maintain Provider network.
- Establish and maintain relationships with Providers.
- Coordinates and implements new Provider contracts with each Provider office and their staff, including education on standard business practices, Provider portal, eligibility verification and other contractual requirements.
- Assists with resolving elevated and complex Provider complaints and/or escalated issues with internal/external partners/customers.
- Maintain and update the appropriate databases and department tools with current information.
- Collaborates with other departments to assist in other Provider related functions.
- Create and maintain Provider Network Management reports as needed.
- Assists in the development and implementation of Provider Network Management processes and procedures.
- Participates in Provider Network Management and Operations meetings.
Job knowledge skills and abilities:
- Effective project management skills and the ability to manage multiple projects at one time.
- Excellent analytical and organizational skills required.
Universal Healthcare MSO, LLC
- Strong attention to detail and ability to analyze same.
- Proficient with computer systems such as MS Office Suite (Word, Excel, PowerPoint, Outlook) and proven ability to learn/use internal company software and hardware.
- Motivated self-starter with the ability to prioritize, multitask, work under pressure and tight deadlines, work independently and effective problem solver.
- Ability to effectively communicate in conveying information to internal and external customers through various methods of communication such as email, letter writing, telephone conversations and in-person interactions.
- Ability to work cooperatively and interact with co-workers, managers, supervisors, and administrators in a manner that promotes a positive work environment.
- Ability to always maintain strict confidentiality.
- Performs other duties as assigned.
Job Type: Full-time
Pay: $24.00 - $28.00 per hour
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
- 8 hour shift
- Monday to Friday
Ability to Commute/Relocate:
- Bakersfield, CA 93312: Reliably commute or planning to relocate before starting work (Preferred)
- Bachelor's (Preferred)
- One location