Provider Network Operations Coordinator

Job Details

Job Location
:
Huntington Beach Office - Huntington Beach, CA 92647

Position Type
:
Full Time

Salary Range
: $20.00 - $24.00 Hourly

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We?✨

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

Why Join Us?🏆

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

The Network Operations Coordinator supports the Provider Network and Provider Configuration teams to maintain Provider Directory. They will help manage and validate all data in Quarterly Rosters received from all contracted groups.

• Execute quarterly outreach to all contracted IPAs/Groups and organize accordingly.
• Manage and maintain rosters for directly contracted hospitals and directly contracted acupuncturists.
• Conduct roster validation which include but is not limited to license, NPI, and credentialing data.
• Manage, store and validate attestations from delegated entities with each roster receival.
• Provide internal communication and distribution to Provider Configuration and Network Analytics departments to support directory upload and network adequacy.
• Properly notify and track all that each roster has been validated and properly distributed with Supervisor via bi-weekly meetings.
• Conduct and log Access & Availability studies on a quarterly basis.
• Distribute Type II PCP IDs to every IPA/Group monthly.
• Provide Outreach and log for Absent Terminations from roster ingestion.
• Same-day processing and tracking of all internal notification for immediate PCP terminations.

• High school diploma required
• Microsoft Excel knowledge and experience
• Previous experience with data management
• Demonstrated ability to manage multiple projects and meet deadlines
• Strong communication and presentation skills with ability to effectively communicate with all levels of the organization, internally and externally
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Wage Range: $20.00 to $24.00 per hour

• Must be able to travel when needed or required
• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.
• Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and affirmative action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law.

A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

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