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PIH Health · 2 days ago

MSO Compliance & Network Coordinator

Whittier, CA

Contract

Onsite

Entry, Mid Level

$30.25/hr - $49.94/hr

2+ years exp

PIH Health is a nonprofit, regional healthcare network serving approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The MSO Compliance & Network Coordinator is responsible for assisting with compliance and audit functions, managing policies and procedures, and maintaining provider management elements.

Health Care

Responsibilities

Assisting with compliance and audit functions of PHP/ MSO (Management Services Organization), including, but not limited to, internal and external audit activities to the Claims, UM, Credentialing, CM functions, and quality improvement initiatives

Monitoring regulatory requirements and understanding how requirements impact MSO operations

Efficiently managing the workflow of policies and procedures, ensuring strict adherence to deadlines, uploading documents, and conducting follow-up reporting

Generating and reviewing policies for MSO, coupled with managing storage and handling of all policy documentation

Ensuring all IPA network provider additions, changes, and deletions are timely communicated and correctly reflected by the PHP network and contracted health plans

Maintaining the integrity of the provider management elements loaded in managed care application databases/software

Triaging all general provider relations issues and address as necessary

Partnering with other PHP departments and working special projects as assigned

Qualification

Managed care complianceProvider relationsMicrosoft SuiteProblem-solvingOrganizational skillsProfessional relationshipsHealthcare ManagementMedicareMediCalICD-9ICD-10 codingCPT-4 codingHCPCS codingCommunication skillsInterpersonal skillsTeamwork

Required

Strong communication skills, verbal, non-verbal, written, and oral

Excellent interpersonal skills with the ability to interact and work effectively with internal and external department, community, and other audiences

Ability to work as part of a team with strong individual contributions

Demonstrates strong and effective problem-solving abilities

Exceptional organizational skills with a proven ability to complete simultaneous tasks and projects in a timely manner

Proficient in computer skills, with an in-depth knowledge of Microsoft Suite (Excel, PowerPoint, Microsoft Word, and Visio)

Foster professional relationships with other departments, working collaboratively to achieve organizational objectives

Two years of experience in managed care compliance

Two years of experience in provider relations field with a managed care organization, IPA, or HMO

Bachelor's Degree in Business Administration, Healthcare Management, Organizational Development, or another related field

Minimum 3 years of experience in the above stated fields will be considered in lieu of Bachelor's Degree