Provider Relations Specialist 24-00324 - Alura Workforce Solutions
Rancho Cucamonga, CA 91730
About the Job
Position
Provider Network Specialist I
Description
Under the direction of the Network and Communication Supervisor, the Provider Network Specialist works to ensure all Direct and Delegated Provider updates are completed timely and accurately. The Specialist works with different departments to ensure all Provider information is received, processed and all databases are updated accurately and in a timely manner and in compliance with regulatory requirements.
Provider Network Specialist I
Description
Under the direction of the Network and Communication Supervisor, the Provider Network Specialist works to ensure all Direct and Delegated Provider updates are completed timely and accurately. The Specialist works with different departments to ensure all Provider information is received, processed and all databases are updated accurately and in a timely manner and in compliance with regulatory requirements.
- Receive, review, and accurately complete Provider daily demographic updates ensuring that the updates do not negatively impact Providers and their practice.
- Complete all updates timely and within service level agreements to avoid delays in Member access to care.
- 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.
- Required complete understanding of Provider affiliations between Direct and Delegated IPAs.
- Complete understanding of the databases that contain Provider information.
- Ensure Provider data integrity in compliance with SB137.
- Maintain Provider Directory data as required by DHCS.
- Ensure to follow standard work for each Provider update type.
- Develop a positive working relationship with Team Members in different departments that affect Provider data.
- Update the Network Development Database (NDDB) accurately ensuring that the update does not affect other Provider affiliations.
- One (1) year of experience in working with Provider network databases.
- High school diploma or GED required.
- Knowledge of the following: Provider network; Network Development Database; relationship between the company and its delegates; the company lines of business. Ability to understand complex requests to update Provider databases. Meet prescribed service level agreements.
- Hybrid- Mon./ Fri. work from home and Tues./Wed./Thurs. onsite
Source : Alura Workforce Solutions
