Managed Care Specialist
Family HealthCare Network · Visalia, California, US
Primary Accountability The Managed Care Specialist is responsible for contributing towards the efforts of the Managed Care department through support of mana...
Job description
Primary Accountability The Managed Care Specialist is responsible for contributing towards the efforts of the Managed Care department through support of managed care contracting requirements, the provider credentialing process, and maintaining IPA relationship(s). Description of Primary Responsibilities: - Responsible for primary IPA and Health Plan day to day interactions and activities, including, but not limited to: - Addressing membership, credentialing, and referral related issues. - Processing and reviewing monthly membership attributions. - Analyzing and identifying membership trends for communication organization wide. - Researching, compiling, and drafting responses to Health Plan patient grievances. - Reviewing and submitting for approval, Health Plan requests for medical records. - Coordinating external party requests for remote EMR access and/or medical record retrieval. - Facilitating the scheduling of Health Plan contractual audit requests alongside FHCN staff and departments. - Active participation in Health Plan based collaborative discussions, trainings, and Community Advisory Committee based meetings. - Responsible for producing and validating monthly reporting re...