L.A. Care Health Plan
Provider Network Account Manager III
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Job Category: Provider RelationsDepartment: Provider Network ManagementLocation: Los Angeles, CA, US, 90017Position Type: Full TimeRequisition ID:
11747Salary Range:
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)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, 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.The Provider Network Account Manager III is responsible for all aspects of the L.A. Care (LAC) provider contracting and relationship management process, including drafting, reviewing, negotiating and implementing phases of contracts, and building, nurturing, and maintaining positive working relationships between LAC and its network of providers. Assigned accounts include multiple large provider organizations (i.e. Participating Physician Group (PPGs); Hospitals; Ancillaries; etc.), or individual practitioners, in a single or multiple locations.Duties
Responsible for identifying, contacting, and actively soliciting qualified providers and/or provider organizations to participate with LAC; assuring the financial integrity of LAC is maintained through rate negotiation; and ensuring contract requirements are adhered to, including language, terms, and reimbursement requirements.Responsible for the project management of all contract implementations and renegotiation functions, from pre-contracting to activation, according to pre-determined internal guidelines and financial standards, while ensuring a smooth transition of services for members.Responsible for drafting contract clauses/addenda, review, and negotiating new contracts/amendments and other contracting related documents based on LAC contracting guidelines, parameters, and standards.Acts as the liaison between Provider Network Management (PNM) and other internal Plan departments, as necessary, to resolve complex issues.Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints, and assisting LAC in investigating any potential quality issues.Researches and resolves contractual interpretation, operational and/or payment issues; educates providers on new protocols, policies, and procedures.Maintains a complete understanding of LAC's reports and metrics to evaluate the performance of assigned providers and/or provider organizations.Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints.Serve as a communication link between provider accounts and LAC. Complete regularly scheduled meetings (site visits, or conference calls) with all accounts.Support all of the LAC PNM departments and assist in the development and distribution of provider engagement material.Education Required
Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred
Master's DegreeExperience
Required:Minimum of 4 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry.At least 4 years of healthcare experience in Managed Care; or, with a physician group, clinical-based organization, and/or in a hospital/facility setting.Skills
Required:Good organizational skills and demonstrate excellent attention to detail and follow up skills.Knowledgeable financial and financial risk analysis.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.Licenses/Certifications Required
Licenses/Certifications Preferred
Medical Coding CertificationRequired Training
Physical Requirements
LightAdditional Information
Required:
Travel to offsite locations for work.Total Provider Management (TPM):
Ensures that the LAC standard provider dataset is complete, accurate, and current.Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.L.A. Care offers a wide range of benefits including:Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness Program
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11747Salary Range:
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)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, 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.The Provider Network Account Manager III is responsible for all aspects of the L.A. Care (LAC) provider contracting and relationship management process, including drafting, reviewing, negotiating and implementing phases of contracts, and building, nurturing, and maintaining positive working relationships between LAC and its network of providers. Assigned accounts include multiple large provider organizations (i.e. Participating Physician Group (PPGs); Hospitals; Ancillaries; etc.), or individual practitioners, in a single or multiple locations.Duties
Responsible for identifying, contacting, and actively soliciting qualified providers and/or provider organizations to participate with LAC; assuring the financial integrity of LAC is maintained through rate negotiation; and ensuring contract requirements are adhered to, including language, terms, and reimbursement requirements.Responsible for the project management of all contract implementations and renegotiation functions, from pre-contracting to activation, according to pre-determined internal guidelines and financial standards, while ensuring a smooth transition of services for members.Responsible for drafting contract clauses/addenda, review, and negotiating new contracts/amendments and other contracting related documents based on LAC contracting guidelines, parameters, and standards.Acts as the liaison between Provider Network Management (PNM) and other internal Plan departments, as necessary, to resolve complex issues.Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints, and assisting LAC in investigating any potential quality issues.Researches and resolves contractual interpretation, operational and/or payment issues; educates providers on new protocols, policies, and procedures.Maintains a complete understanding of LAC's reports and metrics to evaluate the performance of assigned providers and/or provider organizations.Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints.Serve as a communication link between provider accounts and LAC. Complete regularly scheduled meetings (site visits, or conference calls) with all accounts.Support all of the LAC PNM departments and assist in the development and distribution of provider engagement material.Education Required
Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred
Master's DegreeExperience
Required:Minimum of 4 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry.At least 4 years of healthcare experience in Managed Care; or, with a physician group, clinical-based organization, and/or in a hospital/facility setting.Skills
Required:Good organizational skills and demonstrate excellent attention to detail and follow up skills.Knowledgeable financial and financial risk analysis.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.Licenses/Certifications Required
Licenses/Certifications Preferred
Medical Coding CertificationRequired Training
Physical Requirements
LightAdditional Information
Required:
Travel to offsite locations for work.Total Provider Management (TPM):
Ensures that the LAC standard provider dataset is complete, accurate, and current.Salary Range Disclaimer:
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.L.A. Care offers a wide range of benefits including:Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness Program
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