Network Management Specialist (Provider Data Validation)

Title: Network Management Specialist (Provider Data Validation)

Location: San Diego CA

Duration: 6+ months (possible extension)

Responsibilities:

·This position is responsible for the support of all activities related to developing and maintaining the physician, practitioner, group, and/or facility, MPPS and organization services delivery system in small to mid-size market defined by membership, number of providers in delivery system, number of business operating units and lines of business.

·Interacts with all areas of organization to coordinate network management and network administration responsibilities.

·Assesses network needs, analyses network composition, and using organization databases application of regulatory requirements, accreditation entities and other resources, recruits individual, group and/or organizational providers to meet network adequacy standards and assure quality network.

·Conducts and coordinates contracting and amendment initiatives.

·Provides issue resolution and complex trouble shooting for providers.

·Conducts provider education and provider relation activities, providing necessary written materials.

·Conducts administrative provider site visits and coordinates report development and completion according to contractual requirements or ad hoc requests.

·Coordinates Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing status, and evaluation and appropriate actions of quality of care issues and complaints against providers.

·Conducts and manages ongoing audits of provider compliance with policies and procedures as well as contractual obligations for multiple customers. Develops work plans to address audit requirements.

·Works with management to draft, clarify and recommend changes to policies which impact network management.

Requirements/Certifications:

·Daily Responsibilities will include telephonic outreach to targeted providers to educate the providers on data validation regulatory requirements and to secure practice information.

·The expectation is to make 40 outbound calls per day, 5 per hour, averaging 12 minutes each.

·The goal is to reach 2600 Providers and validate by the end of Q2.

·This resource must be proficient logging information into an Excel spreadsheet, and using MS Outlook.

·Candidate will be required to perform subsequent data entry of the providers updated practice information into internal systems as needed, in addition to weekly reporting to CA leadership of telephonic outreach activities and compliance success.

·Bachelor degree required.

·Minimum of 1 year experience in behavioural healthcare related field.

Computer Skills:

·Intermediate knowledge & experience with Microsoft Office Software including Excel, Project, Word, Access, and Power Point, and Outlook.

If you are not interested in looking at new opportunities at this time I fully understand. I would in that case be appreciative of any referrals you could provide from your network of friends and colleagues in the industry. We do offer a referral bonus that I’d be happy to extend to you if they turn out to be a great fit for my client.