L.A. Care Health Plan
Provider Network Account Manager III
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Job Category: Administrative, HR, Business ProfessionalsDepartment: Provider Network ManagementLocation: Los Angeles, CA, US, 90017Position Type: Full TimeSalary 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.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.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. The Account Manager III is responsible for representing LAC in their partnership with contracted and non-contracted providers. Responsibilities include maintaining an in-depth understanding of LAC governing regulations, policies, and procedures, operating standards, provider contracts, and provider performance and needs. The Account Manager III leverages that information to identify, develop, and conduct relevant provider orientation sessions, makes educational visits about LAC practices, policies, and requirements, and works to resolve provider issues.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. Responsible for project management of all contract implementations and renegotiation functions, from pre-contracting to activation, while ensuring a smooth transition of services for members. Responsible for drafting contract clauses/addenda, reviewing, and negotiating new contracts/amendments based on LAC contracting guidelines. Acts as a liaison between Provider Network Management (PNM) and other internal departments to resolve complex issues, ensuring accurate, timely information delivery to assigned accounts. Monitors timely receipt of contractually required reporting.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 implement methods to improve relationships. Responsible for supporting the credentialing and re-credentialing process and assisting LAC in investigating potential quality issues.Education Required
Bachelor's Degree. In 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 excellent attention to detail. Knowledgeable in financial and financial risk analysis. Excellent customer service skills with the ability to make independent judgments and handle multiple projects simultaneously. Must have excellent written and verbal communications skills.Preferred:
Knowledge of ICD-9, ICD-10, and Current Procedural Terminology (CPT) codes. Proven ability to work with a diverse group of people.Licenses/Certifications Required
Licenses/Certifications Preferred
Medical Coding CertificationPhysical Requirements
LightAdditional Information
Required:
Travel to offsite locations for work.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 ProgramNearest Major Market:
Los Angeles
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$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.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.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. The Account Manager III is responsible for representing LAC in their partnership with contracted and non-contracted providers. Responsibilities include maintaining an in-depth understanding of LAC governing regulations, policies, and procedures, operating standards, provider contracts, and provider performance and needs. The Account Manager III leverages that information to identify, develop, and conduct relevant provider orientation sessions, makes educational visits about LAC practices, policies, and requirements, and works to resolve provider issues.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. Responsible for project management of all contract implementations and renegotiation functions, from pre-contracting to activation, while ensuring a smooth transition of services for members. Responsible for drafting contract clauses/addenda, reviewing, and negotiating new contracts/amendments based on LAC contracting guidelines. Acts as a liaison between Provider Network Management (PNM) and other internal departments to resolve complex issues, ensuring accurate, timely information delivery to assigned accounts. Monitors timely receipt of contractually required reporting.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 implement methods to improve relationships. Responsible for supporting the credentialing and re-credentialing process and assisting LAC in investigating potential quality issues.Education Required
Bachelor's Degree. In 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 excellent attention to detail. Knowledgeable in financial and financial risk analysis. Excellent customer service skills with the ability to make independent judgments and handle multiple projects simultaneously. Must have excellent written and verbal communications skills.Preferred:
Knowledge of ICD-9, ICD-10, and Current Procedural Terminology (CPT) codes. Proven ability to work with a diverse group of people.Licenses/Certifications Required
Licenses/Certifications Preferred
Medical Coding CertificationPhysical Requirements
LightAdditional Information
Required:
Travel to offsite locations for work.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 ProgramNearest Major Market:
Los Angeles
#J-18808-Ljbffr