Network Management Coordinator

Job Description

High paced telephone representative supporting Providers and the Provider Relations Department. Duties include provider education regarding our provider web portal, provider orientations, compliance training and claim, referral and eligibility troubleshooting via phone, e-mail or fax. Includes report management, data entry, mail merge and formatting projects on Word and Excel. Candidate must have strong research skills, highly organized with time management and project management skills. Works well under pressure while maintaining pleasant phone etiquette. Works independently and in a team environment. Must have Provider Relations or Customer Service experience. Proficient in Excel and Word. Working knowledge of IDX (internal operating system), Aerial Care (online provider portal) and Office Ally (claims clearinghouse) or comparable systems preferred. **

Responsibilities**

• Support Network Management Department tasks including initial set-up, routine servicing, maintenance, training, retention and membership growth initiatives.
• Adhere to Prospect Medical Policies and Procedures and conduct telephonic trainings and proactive routine outreach to physician offices.
• Responsible for answering incoming (direct or hunt group) calls and conducting outgoing telephone calls to Providers as needed.
• Individual will act as a resource for team members while maintaining a positive attitude and interacting well with individuals on all levels.
• Handle incoming and outgoing e-mail and fax inquiries, answer internal and external calls and conduct outgoing telephone calls to provider offices, internal staff and external vendors to provide assistance or resolution.
• May assist with gathering data for resolutions to claims and capitation/fee for service payment inquires and special projects.
• Document all telephone calls, correspondence and e-mails pertaining to Network Management Provider Relations from Providers and internal staff inquiries in our IDX system and provide timely and thorough responses to all requests received as per Network Management Policies & Procedures.
• Comply with production report requirements as stated in Network Management Provider Relations Department Policies and Procedures.
• Perform business development and event coordination functions on and off-site to support Network Management team with membership growth activities and provider engagement.

Qualifications

Minimum Education: High school diploma or equivalent. **

Minimum Experience: Minimum three (3) years of IPA/HMO setting or equivalent experience in managed care. Three (3) years in Provider or Customer Relations.

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.