Provider Network Administrator
Full Time
Montebello, CA 90640
Posted
Job description
Overview:
Responsibilities:
Qualifications:
The Administrator, Provider Network is responsible for collaborating in managed care growth efforts, with the guidance of Provider Contracting Manager, to achieve financial and other goals. The Staff Business Development Associate will work closely with the Provider Contract Manager to compile and present information on progress, increase brand awareness, bring in new customers and collaborate with public relations efforts. In collaboration with the Provider Contracting Manager, this position will be responsible for identifying new primary care physicians to contract with AltaMed’s IPA as well as developing and managing relationships with partners, Hospitals, Specialists, Ancillary Providers, Health Plans and MSO’s to increase the referrals of senior patients to our PACE programs.
Responsibilities:
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Communicate physician health plan ID numbers to Primary Care Providers.
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Work with Primary Care Providers to obtain membership transfers.
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Manage Primary Care Provider Terminations.
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Enroll at least 10% of contracted Primary Care Provider’s membership with AltaMed.
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Create Financial Comparisons for negotiated Primary Care Provider agreements.
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Negotiate Primary Care Provider Agreements, with the assistance of the Provider Contracting Manager.
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Conduct Primary Care Physician Orientations,once trained by the Provider Contracting Manager.
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Conduct Primary Care Provider site reviews.
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Conduct Primary Care Provider site reviews following a change of address.
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Work to resolve Primary Care Provider’s claims inquiries, as needed, in conjunction with Provider Contracting Manager.
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Make monthly visits to Primary Care Providers.
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Develop relationships with Primary Care Providers.
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Conduct Specialist Provider Access Studies
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Conduct Specialist Provider Orientations, once trained by the Provider Contracting Manager.
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Conduct Specialist Provider Site Reviews
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Conduct Primary Care Provider site reviews following a change of address.
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Enter Primary Care Provider and Specialist Provider service level assessments into Compliance360, with the assistance of the provider relations coordinator.
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Negotiate Capitated Agreements with Specialist Providers, with the assistance of the Provider Contracting Manager,
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Organize internal and external communication to the IPA provider network regarding physician dinners, manager luncheons, and the IPA Newsletter.
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Identify primary care physicians to contract with AltaMed’s IPA in order to build business volume.
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Act as a liaison between the broker community, the plans and providers.
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Work to facilitate the referral of managed care members from other organizations into AltaMed senior programs, as needed.
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Investigate industry trends and competition strategies.
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Network with healthcare providers and industry representatives
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Attend workshops and seminars to keep up-to-date on changes in the industry.
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Adopt a team approach; within the pursuit of common goals.
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Participate in health fairs and other community events to promote managed care programs.
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Represent AltaMed professionally and maintain in-depth knowledge of all its programs and services.
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Drive growth in enrollment numbers.
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Track and report the outcomes of all business development efforts.
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Other Duties as assigned.
Qualifications:
- Education Required. Bachelor’s degree in Business Administration or Health Care Administration; or equivalent years of experience required.
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Experience Required: At least 3 years of experience working in a client relations setting or sales, or customer-oriented service operations.
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Proven track record growing defined book of business in a business sales environment where direct client interaction is a major function.
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Business-to-business sales and client relations experience required.
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