Provider Network Account Manager III
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $88,854 - $142,166 per year
About the role
- Responsible for all aspects of the L.A. Care (LAC) provider contracting and relationship management process
- Drafting, reviewing, negotiating and implementing phases of contracts
- Building, nurturing, and maintaining positive working relationships between LAC and its network of providers
- Representing LAC in their partnership with contracted and non-contracted providers
- Maintaining an in-depth understanding of LAC governing regulations, policies and procedures, operating standards, provider contracts, and provider performance and needs
- Identifying, developing, and conducting relevant and tailored provider orientation sessions
- Monitoring and managing network adequacy by assuring appropriate access to services throughout L.A. County
- Supporting credentialing and re-credentialing process, investigation of member complaints, and assisting in investigating any potential quality issues
- Monitoring timely receipt of contractually required reporting
- Acquiring and maintaining a functional working knowledge of applicable systems like QNXT, Visual Cactus, and proprietary provider databases
Requirements
- Minimum of 4 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry
- At least 4 years of healthcare experience in Managed Care; or, with a physician group, clinical-based organization, and/or in a hospital/facility setting
- Good organizational skills and demonstrate excellent attention to detail and follow up skills
- Knowledgeable financial and financial risk analysis
- Competent computer skills; MS Office skills required
- Must have excellent written and verbal communications skills and the ability to communicate effectively with management and non-management personnel, and LAC provider network physicians
- Proven ability to work with a diverse group of people, including physicians, support staff, coworkers and management.
- Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
contract draftingcontract negotiationregulatory analysisfinancial analysisnetwork adequacy monitoringcredentialingprovider performance managementprovider orientationquality issue investigationreporting
Soft Skills
organizational skillsattention to detailfollow-up skillswritten communicationverbal communicationinterpersonal skillsproblem-solvingrelationship managementteam collaborationdiversity awareness