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.Duties
Identify, contact, and actively solicit qualified providers and/or provider organizations to participate with LAC.Ensure the financial integrity of LAC is maintained through rate negotiation and adherence to contract requirements.Manage all contract implementations and renegotiation functions from pre-contracting to activation.Draft contract clauses/addenda, review, and negotiate new contracts/amendments based on LAC guidelines.Monitor managed care contracts for renewals and expirations.Act as a liaison between Provider Network Management (PNM) and other internal departments.Support the credentialing and re-credentialing process and investigate member complaints.Research and resolve contractual interpretation, operational and/or payment issues.Maintain a complete understanding of LAC reports and metrics to evaluate provider performance.Serve as a communication link between provider accounts and LAC.Support all LAC PNM departments and assist in the development of provider engagement materials.Provide training and mentorship to junior staff.Perform other duties as assigned.Education Required
Bachelor's Degree (or equivalent education and/or experience)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 with excellent attention to detail.Knowledgeable in financial and financial risk analysis.Excellent customer service skills with the ability to handle multiple projects.Strong written and verbal communication skills.Ability to work independently in a fast-paced department.Preferred:Knowledge of ICD-9, ICD-10, and CPT codes.Proven ability to work with a diverse group of people.Demonstrated ability to research issues and bring about resolution.Licenses/Certifications Preferred
Medical Coding CertificationPhysical 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. Provides network adequacy analysis and data to the Network Account Managers.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 AngelesJob Segment:
Relationship Manager, Medical Coding, Medicare, Medicaid, Customer Service, Healthcare
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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.Duties
Identify, contact, and actively solicit qualified providers and/or provider organizations to participate with LAC.Ensure the financial integrity of LAC is maintained through rate negotiation and adherence to contract requirements.Manage all contract implementations and renegotiation functions from pre-contracting to activation.Draft contract clauses/addenda, review, and negotiate new contracts/amendments based on LAC guidelines.Monitor managed care contracts for renewals and expirations.Act as a liaison between Provider Network Management (PNM) and other internal departments.Support the credentialing and re-credentialing process and investigate member complaints.Research and resolve contractual interpretation, operational and/or payment issues.Maintain a complete understanding of LAC reports and metrics to evaluate provider performance.Serve as a communication link between provider accounts and LAC.Support all LAC PNM departments and assist in the development of provider engagement materials.Provide training and mentorship to junior staff.Perform other duties as assigned.Education Required
Bachelor's Degree (or equivalent education and/or experience)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 with excellent attention to detail.Knowledgeable in financial and financial risk analysis.Excellent customer service skills with the ability to handle multiple projects.Strong written and verbal communication skills.Ability to work independently in a fast-paced department.Preferred:Knowledge of ICD-9, ICD-10, and CPT codes.Proven ability to work with a diverse group of people.Demonstrated ability to research issues and bring about resolution.Licenses/Certifications Preferred
Medical Coding CertificationPhysical 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. Provides network adequacy analysis and data to the Network Account Managers.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 AngelesJob Segment:
Relationship Manager, Medical Coding, Medicare, Medicaid, Customer Service, Healthcare
#J-18808-Ljbffr