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Coordinator - Health Plan

1 week ago

Palm Springs, California, United States TotalMed Full time
Coordinator-Health Plan

Job ID #1794104

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About this Role

Responsible for overseeing the day-to-day operations of contracting for DMG and Oasis IPA. Participate in the development of financial and/or operational goals and actively contribute to the achievement of assigned financial and/or operational goals.

Job details

$42.09 / hour

Palm Springs, California

New

Profession: Coordinator

Facility Type: ???

Specialty: Health Plan

Division: MedFi

Start Date: 04/21/2025

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Responsibilities

• Oversees day-to-day operations specialty and ancillary contracting including, but not limited to, management of Contract Specialist and interfacing with physicians, patients and health plans as needed.

• Works with providers to resolve provider performance and compliance concerns, and questions regarding provider contracts and payment for services rendered.

• Maintains specialist and ancillary contract and correspondence files.

• Maintains and distributes the internal central contracts matrix for ancillary and specialty providers to appropriate staff.

• Responsible for meeting governmental requirements and regulations specific to contracting, i.e. AB1455 and new regulation changes. Revises and maintains all contract templates.

• Negotiates provider agreements and presents to management for final approval.

• Responsible for preparation, negotiation and approval of routine LOA's and one time agreements as needed.

• Reviews and approves Specialist network split matrixes and Specialist capitation payments.

• Handles PPO negotiations and follows up on contract issues.

• Responds to all health plan and staff contract questions. Prepares and oversees contract audits and other contract related requests.

Required Qualifications

• High school diploma or equivalent required. Bachelors degree in Business Administration, Finance, Healthcare, or closely related field preferred.

• 5 years recent experience in contracting (Hospital/MSO/Medical group) and knowledge of contracting language and terms required. Negotiation and leadership experience preferred.

• Excellent customer service skills.

• Must possess strong organizational, inter-personal skills and excellent oral and written communication skills.

• Good communication skills, detail oriented, critical thinking and problem solving skills. Excellent customer service and telephone etiquette skills.

• Current California driver's license and proof of insurance