- Conduct physician recruitment and partner with managed care conscious providers.
- Negotiate agreements based on various payment methodologies such as capitation, fee for service, case rate, and flat rates.
- Coordinate with Legal department to ensure compliance and obtain approvals for redlines.
- Decipher financial models and determine budget impact.
- Conduct market analysis for provider coverage and reimbursement requirements and present negotiations to executive leadership for approval as needed.
- Conduct rollout meetings for new capitated agreements, coordinate with other business units to ensure communication is provided to all impacted internal departments and to network providers, system configuration set-up is complete, and establish JOC meeting cadence.
- Coordinate with Network Management and Medical Management teams to provide contracting support.
- Ensure network adequacy in accordance with regulatory time and distance requirements.
- Coordinate and perform tasks to meet all regulatory requirements and execute Prospect's and health plan's policies and procedures.
- On a routine basis review contract templates to ensure contract requirements, special provisions, terms and conditions meets compliance with appropriate laws, regulations, policies, business objectives and industry trends.
- Manage staff to ensure productivity and achieve goals within the determined timeline and established turn around-times.
- Conduct routine one-on-one meetings to set priorities, provide guidance on resolving issues and to provide positive feedback and coaching as needed.
- Conduct performance evaluations and provide training.
- Coordinate and oversee provider adds, terms, demographic updates, and credentialing application submissions timely.
- Disseminate contractual terms to all impacted departments.
- Provide clarity on contractual arrangements and reimbursement structures for internal and external inquiries.
-
Manager, Provider Contracting
3 days ago
Prospect Medical Holdings Orange, United StatesManager of Provider Contracting manages and leads physician contracting activities and negotiations for assigned region. Oversee and supervise staff in maintaining and building assigned networks with full panel of Primary Care Physicians and Specialty providers. Provide guidance ...
-
Specialist, Provider Contracting Operations
3 days ago
Prospect Medical Holdings Orange, United StatesThe Provider Contracting Operations Specialist will assist with maintaining all contract templates, policies and procedures, and coordinate the delivery of documentation with other business units to ensure cohesion. Assist with reviewing and delivering onboarding provider data. W ...
-
Specialist, Provider Contracting Operations
1 week ago
Prospect Medical Holdings Orange, United StatesJob Description · The Provider Contracting Operations Specialist will assist with maintaining all contract templates, policies and procedures, and coordinate the delivery of documentation with other business units to ensure cohesion. Assist with reviewing and delivering onboardi ...
-
Director, Provider Contracts
2 days ago
Molina Healthcare Long Beach, United StatesJob Description · Job Description · Job Summary · Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance, and operational performance, in alignment with Molina Healthcare's ove ...
-
Provider Contract Recruiter
1 week ago
Dental Health Service Long Beach, United StatesJob Description · Job Description · You will contribute to the strength of our team approach to collaborative dental health. · Do you value making an impact and doing meaningful work? Are you ready to be a difference-maker at an established independent Employee-Owned specialize ...
-
Provider Contract Recruiter
1 day ago
Dental Health Service Long Beach, United StatesJob Description · Job Description · You will contribute to the strength of our team approach to collaborative dental health. · Do you value making an impact and doing meaningful work? Are you ready to be a difference-maker at an established independent Employee-Owned specialize ...
-
Provider Contract Recruiter
12 hours ago
Dental Health Services Long Beach, United StatesJob Description · Job DescriptionYou will contribute to the strength of our team approach to collaborative dental health. · Do you value making an impact and doing meaningful work? Are you ready to be a difference-maker at an established independent Employee-Owned specialized hea ...
-
Provider Contracting Specialist, Experienced
2 days ago
Blue Shield of California Long Beach, United StatesThe Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Experienced will report to the Sr Manager of Provider Contracting. In this role you will support Medical Group/ IPA and Ho Specialist, Contract, Experie ...
-
Provider Contracting Specialist, Experienced
4 days ago
Blue Cross and Blue Shield Association Long Beach, United StatesYour Role · The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Experienced will report to the Sr Manager of Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility con ...
-
Provider Contracting Specialist, Experienced
2 days ago
Blue Shield of California Los Angeles, United States Full timeYour Role · The Network Management team handles provider contracting and provider relations statewide. The Provider Contracting Specialist, Experienced will report to the Sr Manager of Provider Contracting. In this role you will support Medical Group/IPA and Hospital/Facility co ...
-
Glazier (Commercial/ Storefront)
3 days ago
California Custom Entrance Systems Orange, United States**Who we are**: · We are a reputable storefront glass and glazing company, specializing in the installation, repair, and maintenance of glass storefronts, windows, and doors for commercial properties. Our team is dedicated to delivering high-quality service and innovative solutio ...
-
Office Manager
1 day ago
Pro-Tek Electrical & Lighting Orange, United StatesJob Overview: · Bookkeeping experience is a must. Responsibilities of this position include but not limited to administrative duties as: · - **Accounts payables and receivables** · - Work Orders/Sales Orders · - Invoicing · - Prepare bank deposits, general ledger postings, and st ...
-
Sewer & Drains Outside Sales Representative
2 days ago
Do It Right Plumbers Inc. Orange, United States**Do It Right Plumbers** is actively seeking a full-time energetic, hardworking **Sewer & Drains Sales Representative** in the **Orange County, California** area. If you are well-known for amazing **customer service skills**, enjoy mapping out **solutions**, and have a knack for ...
-
Office Assistant
16 hours ago
College Community Services Orange, United StatesPathways is seeking an innovative and purpose driven individual to join our team as a Office Assistant for our Wellness Center in the city of Orange. **This position's workdays are Tuesday through Saturday, hours Tuesday through Friday, 8am-5pm, Saturday, 8:30am-5pm. Must be avai ...
-
Peer Mentor
2 days ago
Peer Voices Orange, United StatesOverview: · We are seeking a dedicated and compassionate Peer Mentor to join our team. As a Peer Mentor, you will provide guidance and support to individuals facing mental health challenges, addiction, or behavioral health issues. Your role will involve utilizing your own persona ...
-
Assistant Project Manager
1 day ago
Vanir Construction Management, Inc. Orange, United StatesAbout Vanir: · Vanir has been exceeding client expectations since 1964. Our progressive growth and quality of service has led Vanir to become consistently ranked among the top construction management firms in the nation by _Engineering News-Record_. As we continue growing into ne ...
-
File Clerk
4 days ago
The Matian Firm, APC Orange, United StatesThe Matian Firm in **Orange County** is looking for a **File Clerk** to assist the Immigration Department on a full-time basis. As a File Clerk, you will be assigned administrative and clerical tasks such as; Shredding, filing documents, retrieving files, distributing mail, makin ...
-
Videographer
1 day ago
1 Percent Sports Group Orange, United States1 Percent Sports Group is seeking to add an on-site freelance videographer to become an integral part of our team in Orange County · You will be learning project booking, site filming, and delivery of content. There will be opportunities to grow and learn skills like editing and ...
-
Staff Services Manager Ii
3 days ago
Department of Developmental Services - Headquarters Orange County, CA, United States**_ · **_ · - ** · You will find additional information about the job in the **Duty Statement**. · Working Conditions · - Work is performed in an open-spaced partitioned office environment. Working on a personal computer 85% - 90% of the time. There is approximately 5% - 10% stat ...
-
Attorney - Common Interest Development (Hoa)
16 hours ago
Roseman Law Orange County, CA, United StatesATTORNEY - TRANSACTIONAL · OUR TEAM · Our attorneys have broad and diverse backgrounds both within and outside the practice of law. By focusing on outstanding client service, quality legal work, and community involvement opportunities, we provide an environment that encourages yo ...
Manager, Provider Contracting - Orange, United States - Prospect Medical Holdings
Description
Job DescriptionManager of Provider Contracting manages and leads physician contracting activities and negotiations for assigned region. Oversee and supervise staff in maintaining and building assigned networks with full panel of Primary Care Physicians and Specialty providers. Provide guidance to staff in identifying network needs to negotiate Memorandums of Understanding (MOUs) and contracts with providers to ensure availability and accessibility to members. Audit staff work product (contract documents, fee for service agreements, capitation agreements, case rates and flat rates) to ensure accuracy and cost containment
Responsibilities
Minimum Education: Bachelor's Degree preferred, or equivalent education and experience.
Minimum Experience: Minimum of five (5) years managed care contracting and negotiations preferred. Experience with capitation negotiations and maintenance preferred. Medicare and Medicaid regulations and guidelines preferred.
Req. Certification/Licensure: None.
About Us
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.