Help Desk

TEKsystems•Los Angeles, CA

1d•Onsite

About The Position

This role is responsible for assisting in network growth and development, including preparing contract packets for recruitment projects. The position involves working with Network Managers and providers to obtain necessary signatures and documentation for processing new or existing providers. Key duties include maintaining and updating databases, coordinating the receipt and processing of provider contracts, credentialing, and correspondence. The role also requires timely and accurate completion of PACF's related to provider demographic changes and initial review of credentialing applications. Collaboration with Network Managers is essential to ensure department goals are met. The position involves initial submittal of provider profiles to Health Plans and follow-up to ensure PCP activation. Limited contract negotiations may occur under the direction of management. Daily interaction with regional providers is expected, along with ensuring contract compliance with regulatory agencies. The role serves as an internal network liaison for various departments and may involve on-site visits to providers. Facilitating provider meetings, overseeing database maintenance through audits, and ensuring accurate data reporting are also key responsibilities. Adherence to employee handbook policies, maintaining patient confidentiality in compliance with HIPAA, and performing other assigned duties are required.

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.
Help desk support
Customer service
Phone support

Responsibilities

Assist in Network growth and development to include preparation of contract packets for recruitment projects.
Work with Network Managers and providers to obtain proper signatures and documentation to effectively process newly recruited or existing providers.
Maintain and update 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.
Work 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.
Other duties may be assigned as needed.