Network Contract Specialist

Date: Jun 22, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Team Members are eligible to apply for a transfer or promotion after successfully completing their six-month introductory period AND have no open/active performance improvement plan (PIP). In addition, Team Members must meet the minimum requirements of the position for which they are applying. Member Services Representatives and Registered Nurses must complete one year of service in their current role as well as the requirements above.

 

Position Summary/Position

 

The Network Contract Specialist is responsible for supporting the contracting team in their network expansion efforts. The Network Contract Specialist is responsible for supporting the Contracting team by ensuring interdepartmental communication regarding Provider on-boarding activities is consistent, timely and seamless. The Network Contract Specialist ensures that Provider information gathered by the Contracting team is processed in a timely fashion. The Network Contract Specialist is also responsible for outreach and obtaining information relevant to on-boarding providers. The Network Contract Specialist is responsible for the processing and distribution of provider information to various teams within IEHP.

Major Functions (Duties and Responsibilities)

 

1. Partner with the Contract Team Members in supporting network expansion activities.
2. Solicitation of Network expansion for primary care, specialist, hospital and ancillary Providers in specified geographical areas. 
3. Collaborate in the planning, design and execution of network projects involving regulatory bodies including DMHC, DHCS and CMS.
4. Responsible to streamline the network in specific geographic locations as directed by the Contracting Leadership team.
5. Responsible to engage with contracting team and participate in efforts to ensure that network adequacy standards based on DMHC, DHCS and CMS requirements are met and maintained.
6. Maintain interdepartmental communication and drive execution of decisions made of network activities for various departments within the organization.
7. Responsible to collect provider on-boarding materials and information in support of the Contracting team.
8. Ensure that on-boarding materials received by the Provider are accurate and complete.
9. Maintain consistent communication with Providers to ensure that data elements needed are obtained in a timely fashion.
10. Responsible to address Provider inquiries as they relate to the IEHP process for on-boarding Providers.
11. Update and maintain an accurate account of Provider information in appropriate databases.
12. Assist the Network Contract Representative with routine Provider inquires.
13. Assist the Network Contract Representative with database update and maintenance functions as needed.
14. Support the Contracting team as needed with special projects.

Supervisory Responsibilities

Leading: Self

Experience Qualifications

 

Three (3) years of Healthcare/Health Plan experience required.

Education Qualifications

 

High school diploma or GED required.

Preferred Education

 

Associate’s degree from an accredited institution preferred.

Drivers License Required

No

Knowledge Requirement

 

Understanding in Provider Servicing within the arena of Managed Care.

Skills Requirement

 

Proficient in microcomputer applications (Microsoft Word, Excel, Spreadsheet, and Pivot Tables). Excellent written and verbal communication and interpersonal skills, strong organizational skills, and sound decision-making skills required. 

Abilities Requirement

 

Ability to establish and maintain effective working relationships with others. Detailed oriented. 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

 

Word processing and data entry involving computer keyboard and screens.

Work Model Location

Hybrid

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

 

Starting Salary: $48,110.40  - $59,425.60  

Pay rate will commensurate with experience

 

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. With a provider network of more than 7,000 and a team of more than 2,500 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 a 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