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Provider Network Account Coordinator II (ALD)

Job Category:  Provider Relations
Department:  Provider Network Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  7573

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Provider Network Account Coordinator II works directly with the Contract and Relationship Management staff to support the department's efforts in acquiring, retaining, and analyzing providers; drafting contracts and contract templates; creating provider and operations manuals; information gathering; scheduling and preparing for in person and telephonic meetings; spreadsheet development and maintenance; problem solving and overall representation of the contracted providers within the L.A. Care (LAC) network. This position is responsible for all aspects of administrative support throughout the LAC provider contracting and relationship management process, including preparing and distributing internal notifications as needed; preparing contract documents in accordance with current policy; and, maintaining provider database changes in demographics and/or provider status to include but not limited to tax id changes, terminations and panel closures.  This positionr represents LAC in liaising activities with providers and internal customers, at all times. This position is responsible for maintaining an understanding of LAC governing regulations, policies and procedures, operating standards, provider contracts, and provider performance and needs.  This position is responsible for maintenance of provider contracts, memorandums of understanding, letters of intent, and other administrative documents. This position proactively seeks out available resources to resolve issues/problems.

 

This position monitors timely receipt of information and reporting required to contract with a provider. This position is required to acquire and maintain a functional working knowledge of applicable systems like QNXT, Visual Cactus, and proprietary provider databases, and routinely relay information about additions, deletions, or changes to the LAC Provider Network Management (PNM) internal departments.

 

This position researches and resolves incoming escalated provider inquiries within specified guidelines; and if necessary, educates providers on new protocols, policies, and procedures.  The Account Coordinator is the liaison between PNM and other internal Plan departments, as necessary, to resolve complex issues, and to effectively deliver accurate, timely, and appropriate information.

 

This position supports all of the LAC PNM groups, assists in the development and distribution of provider engagement material (trainings, notices, newsletters); assists in oversight and monitoring efforts; implements LAC provider strategies; and assists in improving the quality of provider data.

Duties

Provides support in the drafting of contract clauses/addenda; review, and negotiation of new contracts/amendments and other contracting related documents based on LAC contracting guidelines; participation of leadership strategy discussions; implementation of contracts/amendments across LAC; and provision of in-service orientation meetings with providers. Responsible for monitoring managed care contracts for renewals and expirations. (30%)

 

Researches and resolves incoming escalated provider inquiries within specified guidelines; and if necessary, educates providers on new protocols, policies, and procedures. Serves as the liaison between provider accounts and LAC, and between PNM and other LAC departments to resolve complex issues, and to effectively deliver accurate, timely, and appropriate information. Supports preparation for regularly scheduled meetings (site visits, or conference calls) with providers or provider groups. Translates information exchange, ideas, requests and other inquiries into actionable items for improved contracting/relationship management and enhanced operational service delivery. (30%)

 

Researches contractual inquiries operational, and/or payment issues; educates providers on new protocols, policies, and procedures. Ensures provider database and documentation is up-to-date, accurate, and complete. (20%)

 

Supports all of the LAC PNM departments (Oversight and Monitoring; Engagement and Strategy; Data Management; and, Operations). Assist in the development and distribution of provider engagement material (trainings, notices, newsletters). Assist in oversight and monitoring efforts. Implement LAC provider strategies. Assist in improving the quality of provider data. (10%)

 

Performs other duties as assigned. (10%)

Education Required

High School Diploma/or High School Equivalency Certificate

Education Preferred

Associate's Degree

Experience

Required:
At least 3 years of experience in contract and/or regulatory analysis in managed care or healthcare industry.

 

At least 3 years of healthcare experience in Managed Care; or, with a physician group, clinical-based organization, and/or in a hospital/facility setting.

 

Preferred:
Project management experience.

Skills

Required:
Competent computer skills; MS Office skills required.

 

Excellent customer service skills with the ability to make independent judgments, handle multiple projects simultaneously, adapt to shifting priorities and utilize time management skills to meet deadlines.

 

Must have excellent written and verbal communications skills and the ability to communicate effectively with management and non-management personnel, and LAC provider network physicians.


Good organizational skills and demonstrate attention to detail and follow up skills.

 

Possess a professional and mature demeanor at all times.


Ability to work in a fast-paced department independently and handle multiple tasks; work with interruptions and deal effectively with confidential information.

 

Preferred:
Knowledge of ICD-9, ICD-10, and CPT codes desired.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information

 

This position is a limited duration positon. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.


L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Relationship Manager, Administrative Assistant, Customer Service, Administrative

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