As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us.
We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
We have an opening for a Provider Relations/ Network Coordinator.
The Network Coordinator is responsible for working as the internal liaison in maintaining, processing and reviewing department databases and reporting on a daily basis to assist the Network Management Department in meeting the overall network growth and development goals.
1.Assist in Network growth and development to include preparation of contract packets for recruitment projects.
2.Responsible to work with Network Managers and providers to obtain proper signatures and documentation to effectively process newly recruited or existing providers.
3.Maintaining and updating the appropriate databases and department tools with statuses.
4.Coordinate receipt and processing of all provider contracts, credentialing, and correspondence.
5.Responsible for timely and accurate completion of PACF's related to incoming documentation received from providers regarding changes to their demographic information in the credentialing and provider network databases.
6.Responsible for initial review of all credentialing applications prior to submittal to RMG Contracts for completion and accuracy.
7.Working collaboratively with Network Managers during the contracting process to ensure department goals and requirements are being met.
8.Responsible for the initial submittal of provider profiles to the Health Plans and follow-up (as requested) to ensure PCP's are active in databases.
9.Limited contract negotiations under the direction of the Director, Network Management and/or Vice President of Regional Operations.
10. Daily interaction with regional providers.
11. Ensure contract compliance and adherence to DMHC, DHS, CMS and other regulatory agencies as required by contracting HMOs.
12. Internal network liaison for Database, Claims, Customer Service, Medical Management, and Provider Relation Departments.
13. Perform on-site visits (as required) to physicians, physician groups, hospitals and ancillary providers.
14. Facilitate the scheduling of meetings with providers.
15. Oversight of database maintenance and accuracy through use of audits.
16. Ensure accurate and timely data reporting requirements are being met.
17. Know and follow the Employee Handbook policies and procedures.
18. Maintain patient confidentiality so that HIPPAA compliance is observed at all times.
19. Other duties may be assigned as needed.
Distribution of work:
Assist with any special projects.
We offer a full benefits package which includes employer paid medical, pharmacy and dental benefits. We offer a generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for our clinical staff.*