PNO Contract Coordinator - Los Angeles, United States - MedPOINT Management

Description

Job Description

Job Description

Summary

Under the general direction of the Provider Network Operations (PNO) Contracting Supervisor, the PNO Contract Coordinator is responsible for the managing and supporting the administrative and operational aspects of the PNO Contracting Team.

This includes but is not limited to pre and post negotiation management, interfacing with PNO, Claims, Utilization Management (UM) and other departments.

The PNO Contract Coordinator performs basic administrative, clerical, operational, customer support and computational tasks to support the PNO Contract Specialist(s) in the network development component of MedPOINT Managements (MPM) service portfolio.

Duties and Responsibilities

Ensure completeness and conduct follow-ups for receipt of provider applications and supporting documents following providers/vendors contract execution

Ensure completeness of health plan required attestations among Clients provider network

Log provider follow-up outcomes and status updates in Letter of Agreement (LOA) Utility; submit to the database to be loaded once signed copy is returned

Perform continued follow-up on all LOAs, both Patient-Specific and Blanket

Complete MPM Contract Routing Checklist upon return to ensure accuracy and completeness of required documents and submit to respective Provider Network Operations database team

Assist Contract Specialists and Contracts Supervisor in responding to Health Plan, IPA, DMHC, DHCS, CMS or regulatory body audit requests

Respond to and close out MPM departmental requests (Claims, Rates, UM etc.) for copies of contracts or amendments

Escalate contract inquiries to Contract Specialist if entity/provider requests rate re-negotiation or amendment; log and track all rate re-negotiation requests

Upload contracts, amendments, Blanket/Patient-Specific LOAs into respective database/storage repository (EZ-CAP Document Management, Laserfiche, Shared Network Folders, LOA Utility)

Participate in weekly B-Report meetings to report on pre-arrivals, communications between hospital LOAs, and pertinent updates

Assist in research of provider-related issues including demographic information, contracting status, credentialing status, claim issues and status in MPM database

Assist in constant analysis of contracting needs, maintaining spreadsheets and collect, track, prepare, compile, and distribute statistical data for daily and monthly reports

Respond to email correspondence and other communication in a professional and timely manner

Ensure HIPAA compliance is always observed/performed

Understand and follow the MPM Employee Handbook policies and procedures

Perform additional duties/assignments as needed

Minimum Job Requirements

Bachelors degree in healthcare, human services or related field preferred

2+ years Managed Care or Healthcare experience in Network Management or Contracting

Knowledge of contracting principles and tools, experience in legal/paralegal process a plus

EZ-CAP knowledge preferred

Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

Substantive knowledge of the HMO marketplace including Medi-Cal, Commercial, and Medicare
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