Senior Network Contract Representative

Job Brief

We have a vacancy of Senior Network Contract Representative in our company, Inland Empire Health Plans. This vacancy is based in Rancho Cucamonga CA 91730. Please go through the job detail mentioned below.

Position Title: Senior Network Contract Representative
Company: Inland Empire Health Plans
Work Type: Contract
City of work: Rancho Cucamonga CA 91730
Salary: $61,422 – $78,312 a year
URL Expiry: 2022-08-14
Posted on: jobsintelecom.net

Job Detail

Position Summary/Position

The Senior Network Contract Representative (Senior NCR) is responsible for ensuring the development and maintenance of strong and consistent relationships with IEHP Network and Non-Network Providers. The Senior NCR serves as a senior liaison for intricate matters involving the contract between IEHP and both Network and Non-Network Providers. The Senior NCR is responsible for investigating and resolving complex provider concerns relating to their IEHP contract. The Senior NCR is responsible for the interpretation and clarification of the most critical IEHP policies and procedures for Network and Non-Network providers. The Senior NCR will investigate, research and analyze, difficult issues, determining root cause to complex problems that are the result of contract implementation. The Senior NCR will lead, direct, 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 complicated concerns Network Providers have involving the IEHP contract.

2. Work with Network Providers on interpreting and clarifying complex contract provisions for understanding and adherence.

3. Educate Network Providers to ensure adherence to IEHP’s contractual compliance standards.

4. Investigate and resolve complicated 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 for sensitive and critical issues as needed in alignment with the Provider Services team.

7. Lead team members and ensure that the proper contract terms are housed in appropriate systems in alliance with the Configuration team.

8. Oversee and ensure the timely processing of contracts in partnership with the Contracts Administration team.

9. Manage the monitoring and tracking via internal system processes Network Provider issues and escalations relating to contract implementation.

10. Interpret complicated IEHP policies and procedures relating to the contract to provide clarity to Network Providers.

11. Monitor and assure internal departmental inquiries are addressed as it relates to contracting concerns in concert with appropriate IEHP business units.

12. Oversee the teams’ instruction on how to process Network and Non-Network Provider applications as needed.

13. Supervise and manage special projects as requested by the Contracts Department leadership team. Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leading: Guides Others Experience Qualifications

A minimum of five (5) 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 be considered in lieu of degree: In lieu of a degree, a minimum of nine (9) 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. Knowledge Requirement

Expert knowledge of Healthcare/Health Plans, Medical Group/IPA, and HMO operations. Strong 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

Must have a valid California driver’s license. 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 periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership. Work Model Location Telecommute 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 – FREQUENTLY Develop and maintain positive work relationships – FREQUENTLY 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

Starting Salary: $61,422.40 – $78,312.00

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.

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