Provider Network Management

Bakersfield, CA
30+ days ago

Job Description

Universal Healthcare MSO, LLC

Provider Network Management:

Job Summary:

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

Benefits:

  • Dental insurance
  • Health insurance
  • Paid time off
  • Vision insurance

Schedule:

  • 8 hour shift
  • Monday to Friday

Ability to Commute/Relocate:

  • Bakersfield, CA 93312: Reliably commute or planning to relocate before starting work (Preferred)

Education:

  • Bachelor's (Preferred)

Work Location:

  • One location

Work Remotely:

  • No

Source

https://www.indeed.com/jobs

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