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Provider Network Specialist I

4 months ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time

**What you can expect**

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an **authentic experience**

Join us as a Provider Network Specialist at IEHP, where accuracy meets efficiency under the guidance of the Network and Communication supervisor. You’ll play a crucial role in completing timely and precise updates for IEHP Direct and Delegated Providers. Dive into the intricacies of Provider affiliations, databases, and regulatory compliance. Your work ensures seamless Member access to care, maintaining data integrity and adhering to SB137standards. Forge positive relationships with cross-functional teams, showcasing your expertise in Provider updates and network development.

**Key Responsibilities**:
1. Receive, review, and accurately complete Provider daily demographic updates ensuring that the updates do not negatively impact Providers and their practice.

2. Complete all updates timely and within service level agreements to avoid delays in Member access to care.

3. Prior to completing updates, review and ensure to understand interdepartmental and intradepartmental connections that impact Provider Network structure, including Contracts, Provider Relations, Credentialing, and Configuration.

4. Required complete understanding of IEHP Provider affiliations between IEHP Direct and Delegated IPAs.

5. Complete understanding of the IEHP databases that contain Provider information.

6. Ensure Provider data integrity in compliance with SB137.

7. Maintain Provider Directory data as required by DHCS.

8. Ensure to follow standard work for each Provider update type.

9. Develop a positive working relationship with Team Members in different departments that affect Provider data.

10. Update the Network Development Database (NDDB) accurately ensuring that the update does not affect other Provider affiliations.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

**Perks**

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
- CalPERS retirement
- 457(b) option with a contribution match
- Generous paid time off
- vacation, holidays, sick
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Paid life insurance for employees with additional options
- Short-term, and long-term disability options
- Pet care insurance
- Flexible Spending Account - Health Care/Childcare
- Wellness programs that promote a healthy work-life balance
- Career advancement opportunities and professional development
- Competitive salary with annual merit increase
- Team bonus opportunities

**Education & Experience**
- One (1) year of experience in working with IEHP Provider network databases
- High school diploma or GED required

**Key Qualifications**
- Knowledge of the following: IEHP Provider network; Network Development Database; relationship between IEHP and its delegates; IEHP lines of business
- Ability to understand complex requests to update Provider databases
- Meet prescribed service level agreements