Provider Network Account Manager II

Provider Network Account Manager II

Job Category: Provider Relations

Department: Provider Network Management

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 11562

Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Provider Network Account Manager II is responsible for all aspects of the L.A. Care (LAC) provider contracting and relationship management process, including drafting, reviewing, negotiating and implementing phases of contracts, and building, nurturing, and maintaining positive working relationships between LAC and its network of providers. Assigned accounts include large provider organizations (i.e. PPGs; Hospitals; Ancillaries; etc.), or individual practitioners, in a single or multiple locations.

The Account Manager II is responsible for representing LAC in their partnership with contracted and non-contracted providers, at all times. The Account Manager II is responsible for maintaining an understanding of LAC governing regulations, policies and procedures, operating standards, provider contracts, and provider performance and needs. The Account Manager II leverages that information to identify, develop, and conduct relevant and tailored provider orientation sessions, make educational visits about LAC practices, policies, and requirements, and work to resolve provider issues. The Account Manager II is responsible for monitoring and managing network adequacy by assuring appropriate access to services throughout L.A. County, and beyond as necessary, to comply with State and Federal requirements for all product lines of business (Medicaid, Medicare, and Commercial). The Account Manager II is responsible for the initial on-board training of new managed care contract provider partners, and for ensuring their provider accounts maintain appropriate trainings and credentials to care for LAC members.

Duties

• Identify and contact providers and/or provider organizations interested in participating with LAC; assure the financial integrity of LAC is maintained through rate negotiation; and ensure contract requirements are adhered to, including language, terms, and reimbursement requirements.
• Manage all contract implementations and renegotiation functions, from pre-contracting to activation, according to pre-determined internal guidelines and financial standards.
• Draft contract clauses/addenda, review, and negotiate new contracts/amendments and other contracting related documents based on LAC contracting guidelines.
• Act as the liaison between PNM and other internal Plan departments to resolve complex issues.
• Support the credentialing and re-credentialing process, investigate member complaints, and assist LAC in investigating any potential quality issues.
• Research and resolve contractual interpretation, operational and/or payment issues; educate providers on new protocols, policies, and procedures.
• Maintain an understanding of LAC reports and metrics to evaluate the performance of assigned providers and/or provider organizations.
• Serve as a communication link between provider accounts and LAC; complete regularly scheduled meetings with all accounts.
• Assist in the development and distribution of provider engagement material.
• Perform other duties as assigned.

Education Required

Bachelor's Degree. In lieu of degree, equivalent education and/or experience may be considered.

Experience Required

At least 3 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry.

At least 3 years of healthcare experience in Managed Care; or, with a physician group, clinical-based organization, and/or in a hospital/facility setting.

Skills Required

• Good organizational skills and demonstrate excellent attention to detail and follow up skills.
• Knowledgeable in financial and financial risk analysis.
• Competent computer skills; MS Office skills required.
• Excellent customer service skills with the ability to make independent judgments.
• Must have excellent written and verbal communications skills.
• Ability to work in a fast-paced department independently and handle multiple tasks.
• Proven ability to work with a diverse group of people.
• Demonstrated ability to research issues and bring about resolution.

Licenses/Certifications Required

Physical Requirements

Light

Additional Information

Required: Travel to offsite locations for work.

TPI: Ensures that the LAC standard provider dataset is complete, accurate, and current. Provides network adequacy analysis and data to the Network Account Managers for the purpose of monitoring and evaluating existing contracts.

Salary Range Disclaimer

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offers a wide range of benefits including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)

Nearest Major Market: Los Angeles

Job Segment: Relationship Manager, Medicaid, Medicare, Customer Service, Healthcare