Receive all new contracts and manage process flow required to initiate implementation components (notify QM to begin site visit proceedings, system updates, etc).
Assist in Provider Services (E.G. Provider inquiries, Health Plan communication, coverage plans, etc.)
Manage and process provider changes, contact affiliations and specific data management requirements (MCL).
Facilitate and assist with the credentialing process requirements
Generate Provider directories within specified time frames (both internal and external directories)
Correspondence with all contracted health plans pertaining to all provider communication
Update contracts and amendments for all IPAs.
Log and track all new contracts and make changes as necessary
Distribute provider and health plan contracts and/or amendments to pertinent PPMC individuals
Verify credentialing packets are completed upon submission to PPMC, and liaison between credentialing dept. and provider relations managers for providers that are out of compliance with credentialing documents
Provide Network Rosters upon request.
Outline contract/provider details to Configuration for provider additions and/or changes to provider information via tickets submitted to Spiceworks.
Scan approved contracts, correspondence, amendments, and other related documentation in AdVantage Framework.
Assist Provider Relations Managers with inquiries.
Review NPIs and Tax IDs with all contracts submissions
Track all Primary Care Provider changes submitted to health plans and follow up with health plans to ensure that changes have taken effective confirmation on the date that changes took effect in the health plan system.
Provide contract and provider info. for all audits of contracted IPAs and PPMC
Resolve errors in Advantage Framework and Express
Liaison between contracted health plans and necessary PPMC staff to resolve the any issues.
Assist Eligibility and IS Dept. with membership fallouts
Provider registration on Connect.
Assist Capitation, claims, health services with any contract and/or provider related inquiry.
Perform other duties as required
Education: Bachelor’s degree in healthcare or related field or equivalent experience.
Knowledge: In-depth knowledge of managed care concepts, ability to meet established deadlines, communicate effectively, Achieve high quality results. Ability to interpret contract and health plan regulatory language.
Experience: Minimum three (3) years experience in a provider network environment within the healthcare industry.
The passion to change the way healthcare is delivered permeates everyone and everything at agilon health. Working together we can use our expertise to make a difference in the lives of patients and physicians alike. We can bring the joy back to practicing medicine for physicians and improve the care experience for patients across the country.
We believe that every member of our team plays a critical role in transforming care for our patients. Our customer service teams are the front line for physicians and patients navigating the system and, without our claims processing departments, our health plan partners and provider networks couldn’t do their jobs. No matter what your role is at agilon health, you can and will make a difference in the lives of the seniors and Medicaid populations we serve. Our culture and passion has already been embraced by nearly 500 employees in three states. And we are excited to welcome new members to the team as more physicians and patients experience the difference agilon health can make.
Role: Provider Relations Coordinator
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