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Company: Network Medical Management Inc
Location: Monterey Park
Posted on: January 12, 2022

Job Description:

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: Other duties may be assigned.Validate and uphold the integrity of provider database adhering to SB-137 compliance.Act as liaison between internal departments (Contracting, Credentialing, Provider Relations, Terms and Conditions, Eligibility, PDM) and external (Health Plans) entities to effectively communicate and follow-up in a timely manner to resolve provider inquiries and requests.Verify contract rates and/or fee schedule input correctly for vendors and providers.Review providers add, termination, and demographic update requests.Maintain and update providers' health plan unique identification numbers across all lines of business.Identify providers' data error and coordinate with responsible parties to correct.Accurately log all providers' requests and be able to provide monthly summary to Director and Team Lead.Audit providers' membership assignment based on Shared/Full Risk contract and PPG codes.Adhere to corporate standards for performance metrics, data integrity, and reporting format to ensure high quality, meaningful output.Perform other duties as necessary or assigned by the Director or Team Lead.SUPERVISORY RESPONSIBILITIESThis job has no supervisory responsibilities.QUALIFICATIONSTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals to perform the essential functions. Knowledge of MS Word, Excel and basic medical terminology is required. Ability to understand and work with proprietary software applications. Organizational ability and ability to exercise good judgment. Typing speed 30+ WPM and knowledge of 10 key desired.EDUCATION and/or EXPERIENCEBachelor's degree (B.A) or two years of college; or five years related experience and/or training; or equivalent combination of education and experience. Requires an associate's degree and at least 2 years experience in working with excel, accounting, clerical, and office setting.#LPIND

Keywords: Network Medical Management Inc, Monterey Park , PROVIDER GRID OPERATIONS COORDINATOR, Other , Monterey Park, California

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