Provider Network Administrator - Alameda County Fremont, CA
Job description
People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.
Imperial Health Plan of California, Inc. is approved by California Department of Managed Health Care to offer full-service Medicare Advantage coverage, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliate, Imperial Insurance Companies, Imperial also offers Medicare Advantage plans in Texas, New Mexico, Utah, and Arizona.
Our Mission: To deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.
Our Vision: To deliver value based care that is clinically effective, sustainable, and achieves exceptional outcome.
POSITION SPECIFICS:
This is for Alameda County in CA
JOB DUTIES:
Maintains a successful working relationship between Imperial Health Plans, network providers, and partner health plans through a full range of provider relations and service interactions to ensure network adequacy, and provider relations. Identify and communicate operational issues raised by providers, respond to customer complaints, customer satisfaction surveys and provider questions, and research and resolve accounts payable issues. Routinely negotiate cost effective fees for single services, confirm service capability and educate providers on contract expectations, processes, and paperwork. Comprehend detailed knowledge of Imperial’s requirements in order to adapt agreements, contractual requirements and fee agreements to the specific situation. Must be able to routinely evaluate and analyze the most beneficial solution for Imperial and our network providers in a variety of circumstances.
ESSENTIAL JOB FUNCTIONS:
1. Assess and resolve specific provider concerns, developing and implementing solutions that are beneficial to providers, Imperial Members and Imperial.
2. Maintain network adequacy. Lead efforts to obtain letter of agreements as necessary.
3. Onboard new providers within 10 business days. Train providers on an annual basis.
4. Assess and respond to leads generated by brokers, providers, and customers.
5. Negotiate fees that align provider needs and Imperial business objectives. Educate providers on fee structures to ensure collaborative agreement and understanding of Imperial Services and the fees associated with them.
6. Staff Provider Relations Telephone Queue, adequately respond to and resolve incoming calls in the appropriate manner.
7. Respond to Customer Satisfaction Surveys and Customer Complaints within the required time frame through investigation and problem solving that results in positive outcomes.
8. Provide explanations and information to others on topics within area of expertise.
9. Proactively review and maintain provider compliance documents to ensure active status within provider network.
10. Collaborate with other departments to assign qualified providers to orders within the contractually allowed mileage radius of the patient's home zip code.
EDUCATION/EXPERIENCE:
· Bachelor’s Degree (or higher) in Business, Marketing, Communications or healthcare related field
. 3+ years of related experience in provider relations, network management, customer service, contract negotiations, account services and/or account management, etc. (or High School Diploma / GED and 3+ years of related experience)
SKILLS/KNOWLEDGE/ABILITY:
· Microsoft Office Suite (Word, Outlook, Excel
· Knowledge of negotiating rates and managing subcontractor relationships
· Knowledge of Medicare and Medical terminology (preferred)
MUST HAVE: Driver's License and reliable transportation with automobile insurance.
Job Type: Full-time
Pay: $65,000.00 - $66,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Referral program
- Retirement plan
- Vision insurance
Schedule:
- 8 hour shift
Experience:
- Network administration: 1 year (Preferred)
Work Location: On the road
