Network Coordinator

Regal Medical Group•Orange, CA

1d•$23 - $25

About The Position

The Coordinator, Network Management is responsible for working as the internal liaison in maintaining, processing and reviewing department databases and reporting on a daily basis to assist the Network Management Department in meeting the overall network growth and development goals.

Requirements

Minimum of 2 years relevant work experience in Network Management in a managed care setting, health plan or large medical group administration.
Knowledge of contracting principles/tools.
Excellent verbal and written communication skills.
Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
Must be able to travel within service area and have valid driver’s license and insurance.

Responsibilities

Assist in Network growth and development to include preparation of contract packets for recruitment projects.
Responsible to work with Network Managers and providers to obtain proper signatures and documentation to effectively process newly recruited or existing providers.
Maintaining and updating the appropriate databases and department tools with statuses.
Coordinate receipt and processing of all provider contracts, credentialing, and correspondence.
Responsible for timely and accurate completion of PACF’s related to incoming documentation received from providers regarding changes to their demographic information in the credentialing and provider network databases.
Responsible for initial review of all credentialing applications prior to submittal to RMG Contracts for completion and accuracy.
Working collaboratively with Network Managers during the contracting process to ensure department goals and requirements are being met.
Responsible for the initial submittal of provider profiles to the Health Plans and follow-up (as requested) to ensure PCP’s are active in databases.
Limited contract negotiations under the direction of the Director, Network Management and/or Vice President of Regional Operations.
Daily interaction with regional providers.
Ensure contract compliance and adherence to DMHC, DHS, CMS and other regulatory agencies as required by contracting HMOs.
Internal network liaison for Database, Claims, Customer Service, Medical Management, and Provider Relation Departments.
Perform on-site visits (as required) to physicians, physician groups, hospitals and ancillary providers.
Facilitate the scheduling of meetings with providers.
Oversight of database maintenance and accuracy through use of audits.
Ensure accurate and timely data reporting requirements are being met.
Know and follow the Employee Handbook policies and procedures.
Maintain patient confidentiality so that HIPPAA compliance is observed at all times.
All other duties as directed by management.
Assist with any special projects.