Network Contract Representative

Date: Nov 17, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 8237 

 

Position Summary/Position

 

The Network Contract Representative (NCR) is responsible for developing and maintaining strong and consistent relationships with IEHP Network and Non-Network Providers. The NCR serves as a liaison for matters involving the contract between IEHP and both Network and Non-Network Providers. The NCR is responsible for investigating and resolving provider concerns relating to their IEHP contract. The NCR is responsible for the interpretation and clarification of IEHP policies and procedures for Network and Non-Network providers. The NCR will research and analyze, determining root cause to problems that are the result of contract implementation. The NCR will engage and collaborate with key stakeholders in various departments within the organization that have direct involvement with provider contracts.

Major Functions (Duties and Responsibilities)

 

1. Engage with Providers and resolve concerns Network Providers have involving the IEHP contract.
2. Work with Network Providers on interpreting and clarifying contract provisions for understanding and adherence. 
3. Educate Network Providers to ensure adherence to IEHP’s contractual compliance standards.
4. Resolve contract issues involving claims payments in collaboration with the Claims team.
5. Manage and maintain regulatory compliance deliverables and collaborate with the Compliance team on deliverables.
6. Provide contract clarification and interpretation as needed in alignment with the Provider Services team.
7. Establish the proper contract terms are housed in appropriate systems in alliance with the Configuration team.
8. Oversee timely processing of contracts in partnership with the Contracts Administration team.
9. Monitor and track via internal system processes Network Provider issues and escalations relating to contract implementation.
10. Interpret IEHP policies and procedures relating to the contract to provide clarity to Network Providers.
11. Assure internal departmental inquiries are addressed as it relates to contracting concerns in concert with appropriate IEHP business units.
12. Instruct team on how to process Network and Non-Network Provider applications as needed.
13. Lead special projects as requested by the Contracts Department leadership team.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Leading: Self

Experience Qualifications

 

A minimum of three (3) or more years of which include direct experience in a Healthcare/Health Plan setting, containing working knowledge of Medical Group/IPA, and HMO operations, and Network Development. 

Preferred Experience

Education Qualifications

 

Bachelor's degree from an accredited institution required.

Significant experience may be considered in lieu of degree: In lieu of a degree, a minimum of seven (7) years of relevant work experience is required.

Preferred Education

Professional Certification

Professional Licenses

Drivers License Required

Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement

 

Working knowledge of Healthcare/Health Plans, Medical Group/IPA, and HMO operations. Understanding of Provider contracts and claims processing guidelines.

Skills Requirement

 

Strong organizational skills. Excellent written and verbal communication and interpersonal skills. Microcomputer Applications (Microsoft Word and Excel, Access preferred) for use in all aspects of an office environment. Skilled data input.

Abilities Requirement

 

Ability to cultivate and maintain effective working relationships with internal and external partners. Telephone courtesy with a high level of patience. Time management and prioritization abilities.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

Data entry involving computer keyboard and screens, automobile travel within the IEHP service area, distribution of reports and supplies to outside provider offices. Word processing involving computer keyboard and screens.

Position is eligible for telecommuting/remote work location model upon completing the necessary steps and receiving HR approval. The incumbent approved to telecommute may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership.

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Sitting - CONSTANTLY
Lighting - CONSTANTLY
Indoors - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY
Keyboarding: Other - FREQUENTLY
Use of computer mouse - FREQUENTLY
Hearing: In a group - FREQUENTLY
Hearing: Over the Telephone/Cell Phone - FREQUENTLY
Hearing: Conference Speakers/Video Calls/Radio Calls - FREQUENTLY
Communicate: Verbally engage with customer base - FREQUENTLY
Communicate: Give instructions, advise, warn, instruct - FREQUENTLY
Perform complex and varied tasks - CONSTANTLY
Develop and maintain positive work relationships - CONSTANTLY
Regular contacts: recurring clients - FREQUENTLY
Other contacts: public exchange - FREQUENTLY
Other contacts:one-time clients - FREQUENTLY
Decision-making - FREQUENTLY
Lead/Influence Others - FREQUENTLY
Rapid Pace of work - FREQUENTLY
Problem Solving - FREQUENTLY

A reasonable salary expectation is between $53,892.80 and $68,702.40, based upon experience and internal equity.

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles