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Job Description
nJob Description
nJOB TITLE: Contracting Specialist FLSA STATUS: Non-Exempt
nDEPARTMENT: Provider Network Management
nREPORTS TO: Sr. Manager, Provider Network Management
nJOB SUMMARY: Will provide support to Contracting Manager in closing gaps and developing the network. Researching and contracting all specialties and Hospitals in our current counties/states and upcoming states and counties.
nESSENTIAL JOB FUNCTIONS:
nnWill use Microsoft Word/Excel to put together and track emails/ faxes and the necessary paperwork for credentialing and contracting as assigned.
nResponsible for following up with the providers to collect all paperwork for contracting. Getting the contracts signed.
nAssist with requests that come through Contracting:
n nnContracting (Expansion and current service areas)
nCollect data from the Providers for Credentialing
nRespond to LOA requests.
nNetwork Gaps analysis and recovery
nAnswer provider inquiries on status of credentialing
nResearch and call potential new providers for contracting in all service areas new and existing.
n nn Assure that all contracts are completed and given to contracting coordinator for upload.
n Find providers for any incidents that should come into the Contracting queue.
n Provides a daily/weekly summary of the success rate of the above by geographic region and specialty.
n Frequently contacts providers via phone to follow up on contracts and credentialing documentation.
n Travel may be required to visit provider offices to obtain necessary documentation or contracts.
n Travel may be required to the new counties/States to recruit for network.
n Supports the Contracting needs of the Provider Network Management department.
n Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
n Maintains regular and consistent attendance.
n Adheres to Compliance Plan and HIPAA regulations.
n nMARGINAL JOB FUNCTIONS:
nnTakes on special projects as needed.
nPerforms other duties as assigned.
n nBEHAVIORAL EXPECTATIONS:
n**** 1. Continuous Learning:
na. Attends staff meetings as required.
nb. Attends appropriate training, seminars and workshops as required
n2. Customer Focus:
na. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations and IMAS’s Standards of Conduct.
nb. Fosters appropriate communication and relations with Supervisor, co-workers and other staff.
n3. Quality/Process Improvement/Safety
na. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.
nb. Supports and demonstrates safety throughout all duties performed.
nc. Follows established policies and procedures and understands and complies with all regulators standards set forth by governing entities.
nPOSITION REQUIREMENTS:
n** EDUCATION/EXPERIENCE:**
nnHigh school graduate or equivalent.
nAt least 2-3 years prior Health Plan Contracting-Specialists, Hospitals and Primary Care.
n n** SKILLS/KNOWLEDGE/ABILITY:**
nnProficient with Microsoft Suite (Word, Excel, etc.)
nStrong phone/customer service skills
nMust be detail orientated.
nWillingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to members and staff.
nWillingness and ability to follow written and verbal direction in English.
nWillingness and ability to maintain appropriate level of confidentiality and privacy.
nWillingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
nWillingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.
nWillingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
nAbility to effectively prioritize items/tasks as required.
nWillingness and ability to take initiative and be a self-starter.
nWillingness and ability to understand and comply with Federal, State, and local regulations.
n n** LICENSURE/CERTIFICATE/TRAINING:**
nnn/a
n
Worksite address
pasadena, CA, 91122, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.