Cedars-Sinai Health Plan Network Coordinator in Beverly Hills, California

Requisition #: M11900
Working Title: Health Plan Network Coordinator
Business Entity: MDN - Medical Delivery Network
Cost Center # - Cost Center Name: 0853015 - MNS - Managed Care
City: Beverly Hills
Job Category: Allied Health/Clinical
Job Specialty: Other Allied Health
Position Type: Regular-F/T
Shift Length: 8hr
Hours: 8:00 a.m. - 5:00 p.m.
Days: Monday - Friday
Shift Type: Day
Weekends: None

Job Posting: With the interest of optimizing payor network participation, the Health Plan Network Coordinator is responsible for the process of ensuring physicians are properly registered with contracted, non-contracted commercial and other payors as needed.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

•Gather needed documents from MNS Credentialing Department or physician clientele.

•Acts as MNS distribution point to report individual provider data to contracted health plans.

•Coordinate and prepare provider applications with contracted payors, as needed.

•Maintain panel status and other payor correspondence records for each physician.

•Assist physicians, secretaries, and other assigned staff with application procedures, as needed.

•Submit applications to payors and track their progress in registering physicians

•Use spreadsheet to track and publish (intranet) provider’s status with forms completion and payor registration

•Periodically audit payor reports and provider listings to ensure accurate and complete participation of MNS-represented physician networks.

•Assist with the proper maintenance of Credentialing database and other internal tracking mechanisms (e.g. Task Roster, PPO Status Grid, etc.)

•Special projects as assigned.

Qualification Requirements/Preferences:

Education Certifications/Licensure Experience Physical Abilities QUALIFICATIONS

EDUCATION AND/OR EXPERIENCE:

High school diploma; A.A. degree preferred; 2 years billing or provider network management experience preferably in a managed care environment; computer literacy to include proficient use of Windows NT, MS-Word, Excel and Access.

LANGUAGE SKILLS:

Verbal communication skills including effective telephone dialogue skills and letter writing. Ability to read and interpret documents, routine reports and correspondence.

MATHEMATICAL SKILLS:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

REASONING ABILITY:

Able to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Proven team worker with excellent customer relations skills.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is occasionally required to stand and walk. The employee must frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT:

The noise level in the work environment is usually moderate.

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Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.