Job Posting: With the interest of optimizing payor network participation, the Health Plan Network Coordinator is responsible for the process of ensuring physicians are properly registered with contracted, non-contracted commercial and other payors as needed. ESSENTIAL DUTIES AND RESPONSIBILITIES:
Gather needed documents from MNS Credentialing Department or physician clientele.
Acts as MNS distribution point to report individual provider data to contracted health plans.
Coordinate and prepare provider applications with contracted payors, as needed.
Maintain panel status and other payor correspondence records for each physician.
Assist physicians, secretaries, and other assigned staff with application procedures, as needed.
Submit applications to payors and track their progress in registering physicians
Use spreadsheet to track and publish (intranet) provider's status with forms completion and payor registration
Periodically audit payor reports and provider listings to ensure accurate and complete participation of MNS-represented physician networks.
Assist with the proper maintenance of Credentialing database and other internal tracking mechanisms (e.g. Task Roster, PPO Status Grid, etc.)
Special projects as assigned.
Qualification Requirements/Preferences: Education Certifications/Licensure Experience Physical Abilities QUALIFICATIONS EDUCATION AND/OR EXPERIENCE: High school diploma; A.A. degree preferred; 2 years billing or provider network management experience preferably in a managed care environment; computer literacy to include proficient use of Windows NT, MS-Word, Excel and Access. LANGUAGE SKILLS: Verbal communication skills including effective telephone dialogue skills and letter writing. Ability to read and interpret documents, routine reports and correspondence. MATHEMATICAL SKILLS: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. REASONING ABILITY: Able to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Proven team worker with excellent customer relations skills. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee is occasionally required to stand and walk. The employee must frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus. WORK ENVIRONMENT: The noise level in the work environment is usually moderate.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scien...tists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.