Coordinator - Health Plan
Apply NowCompany: TotalMed
Location: Palm Springs, CA 92262
Description:
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
Apply
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
Job ID #1794104
| Share
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
Apply
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