Alta Hospitals
Network Specialist - Full Time, Days
Alta Hospitals, Johnston, Rhode Island, us, 02919
The Provider Network Coordinator provides both high level administrative support and data analytic support. Gathers, organizes, and maintains information for efficient access, and develops and maintains spreadsheets and reports. Serves on several committees and prepares minutes, communicates policies and procedures, and secures clarification as needed. Works closely with local team as well as central team in CA. This role will be cross trained in the areas of Contracting, Claims, Customer Service, Database Management and Provider Relations.
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
The essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position. IPA Governance Responsible for all aspects of preparation for IPA Board and Committee and General Membership meetings including but not limited to the following: Work directly with RI SVP on all Governance related activities. Ensure accurate and timely scheduling of all meetings. Ensure agenda materials are prepared for senior leadership review at least seven business days prior to the meetings. Ensure agenda and materials are distributed prior to each meeting. Work directly with IPA CMO and IPA leaders coordinating the POD meeting and other IPA Committee meeting agendas (meeting notices Textedly & email) and minutes. Ensures all provider credentialing and recredentialing information is received timely. Prepares documents and correspondence, demonstrating excellent writing, editing, proofreading skills. Effectively coordinates activities associated with meeting management, transcription of minutes, and follow-up.? Supports network team with management of contractual payments to practices and providers. Documents and tracks workflows and policies related to weekly, monthly and annual payments. Maintains positive business relationships to ensure retention of existing providers, therefore decreasing the potential membership loss due to provider terminations. Provides report of any potential terminations and strategizes to salvage relationship and/or retain membership. Coordinates successful implementation of any membership transfers to ensure members remain with the company, to include developing transition plans with Member Relations to achieve the greatest retention of members, coordinating meet and greet functions with receiving physician office, developing member letters for receiving physician to send out, etc. Assist with the development and production of marketing materials. Assist with the development, production, and distribution of internal and external communication materials. Proficiency in word, excel, pivot tables, PowerPoint. Excellent verbal communication skills and interpersonal skills Able to establish rapport and interact well with individuals on all levels. Able to work with others while completing multiple tasks simultaneously and successfully. Maintain a professional image and attitude. Exceptional customer service skills Strong public speaking and presentation skills Able to prioritize and organize multiple tasks. Ability to make decisions in the absence of detailed instructions and work independently or in a team environment. Generating strong leads for new business development opportunities including new Medicare/Medi-Medi conversions and/or IPA conversions 4-year college degree preferred Operations experience strongly recommended. Previous supervisory experience preferred. Minimum of 3 years of HMO/IPA/Health System experience in Provider Relations or Contracting
The essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position. IPA Governance Responsible for all aspects of preparation for IPA Board and Committee and General Membership meetings including but not limited to the following: Work directly with RI SVP on all Governance related activities. Ensure accurate and timely scheduling of all meetings. Ensure agenda materials are prepared for senior leadership review at least seven business days prior to the meetings. Ensure agenda and materials are distributed prior to each meeting. Work directly with IPA CMO and IPA leaders coordinating the POD meeting and other IPA Committee meeting agendas (meeting notices Textedly & email) and minutes. Ensures all provider credentialing and recredentialing information is received timely. Prepares documents and correspondence, demonstrating excellent writing, editing, proofreading skills. Effectively coordinates activities associated with meeting management, transcription of minutes, and follow-up.? Supports network team with management of contractual payments to practices and providers. Documents and tracks workflows and policies related to weekly, monthly and annual payments. Maintains positive business relationships to ensure retention of existing providers, therefore decreasing the potential membership loss due to provider terminations. Provides report of any potential terminations and strategizes to salvage relationship and/or retain membership. Coordinates successful implementation of any membership transfers to ensure members remain with the company, to include developing transition plans with Member Relations to achieve the greatest retention of members, coordinating meet and greet functions with receiving physician office, developing member letters for receiving physician to send out, etc. Assist with the development and production of marketing materials. Assist with the development, production, and distribution of internal and external communication materials. Proficiency in word, excel, pivot tables, PowerPoint. Excellent verbal communication skills and interpersonal skills Able to establish rapport and interact well with individuals on all levels. Able to work with others while completing multiple tasks simultaneously and successfully. Maintain a professional image and attitude. Exceptional customer service skills Strong public speaking and presentation skills Able to prioritize and organize multiple tasks. Ability to make decisions in the absence of detailed instructions and work independently or in a team environment. Generating strong leads for new business development opportunities including new Medicare/Medi-Medi conversions and/or IPA conversions 4-year college degree preferred Operations experience strongly recommended. Previous supervisory experience preferred. Minimum of 3 years of HMO/IPA/Health System experience in Provider Relations or Contracting