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    Contracting Coordinator - Pasadena, United States - Imperial Health Plan of California, Inc.

    Imperial Health Plan of California, Inc.
    Imperial Health Plan of California, Inc. Pasadena, United States

    3 weeks ago

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    Healthcare
    Description

    People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.

    Imperial Health Plan of California, Inc. is approved by California Department of Managed Health Care to offer full-service Medicare Advantage coverage, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliate, Imperial Insurance Companies, Imperial also offers Medicare Advantage plans in Texas, New Mexico, Utah, and Arizona.

    Our Mission: To deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.

    Our Vision: To deliver value based care that is clinically effective, sustainable, and achieves exceptional outcome.

    JOB SUMMARY: Will provide administrative support to Contracting Manager in closing gaps and developing the network. Will perform administrative tasks to send contracts, documentation to the providers and add credentialing documents into the Share Point.

    ESSENTIAL JOB FUNCTIONS:

    Will use Microsoft Word/Excel to put together and track emails/ faxes and the necessary paperwork for credentialing and contracting as assigned.

    Responsible for following up with the providers to collect all paperwork for contracting.

    Assist with requests that come through the Provider portal

    Contracting (Expansion and current service areas)

    Collect data from the Providers for Credentialing

    Respond for LOA requests

    Network Gaps analysis and recovery

    Answer provider inquiries on status of credentialing

    Share Point clean up and Rejects

    Research and call potential new providers for contracting in all service areas new and existing

    Assure that all contracts are completed and loaded in EZCAP with the correct fee schedule and status.

    Find providers for any incidents that should come into the Contracting queue.

    Maintain day to day incidents with Providers, so we can bring to the attention of the IPA.

    Provides a daily/weekly summary of the success rate of the above by geographic region and specialty.

    Frequently contacts providers via phone to follow up on contracts and credentialing documentation.

    Maintain day to day relationship with all health plans contracted with Imperial and will be the point of contact for Imperial to keep the dept up to date with all health plan requests.

    Travel may be required to visit provider offices to obtain necessary documentation or contracts.

    Supports the administrative needs of the Network Management department.

    Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.

    Maintains regular and consistent attendance.

    Adheres to Compliance Plan and HIPAA regulations.

    MARGINAL JOB FUNCTIONS:

    Takes on special projects as needed.

    Performs other duties as assigned.

    BEHAVIORAL EXPECTATIONS:

    1. Continuous Learning:

    a. Attends staff meetings as required.

    b. Attends appropriate training, seminars and workshops as required

    2. Customer Focus:

    a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

    and IMAS's Standards of Conduct.

    b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff.

    3. Quality/Process Improvement/Safety

    a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.

    b. Supports and demonstrates safety throughout all duties performed.

    c. Follows established policies and procedures and understands and complies with all regulators

    standards set forth by governing entities.

    POSITION REQUIREMENTS:

    EDUCATION/EXPERIENCE:

    High school graduate or equivalent.

    SKILLS/KNOWLEDGE/ABILITY:

    Proficient with Microsoft Suite (Word, Excel, etc.)

    Strong phone/customer service skills

    Must be detail orientated

    Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to members and staff.

    Willingness and ability to follow written and verbal direction in English.

    Willingness and ability to maintain appropriate level of confidentiality and privacy.

    Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.

    Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.

    Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.

    Ability to effectively prioritize items/tasks as required.

    Willingness and ability to take initiative and be a self-starter.

    Willingness and ability to understand and comply with Federal, State, and local regulations.

    LICENSURE/CERTIFICATE/TRAINING:

    n/a

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