Provider Network AssistantBrandman Centers for Senior Care (BCSC) 20.00 - 23.00
We value our employees! We offer long term employment opportunities with job stability, including supporting and encouraging career growth advancement. We offer Health, Dental and Vision insurance, Paid Time Off, 9 Paid Holidays, 403(b) with Matching Retirement Plan, Life insurance (paid by the company) and a team spirit workplace culture!
Candidates should be aware that Los Angeles Jewish Health (LAJH) currently maintains a policy requiring employees to be fully vaccinated. New LAJH employees should be fully vaccinated (i.e., two weeks after last dose) by their start date. LAJH is an equal opportunity employer, and will provide reasonable accommodation to those unable to be vaccinated where it is not an undue hardship to the company to do so as provided under federal, state, and local law.
Provider Network Assistant
Under the direction and supervision of the Brandman Centers for Senior Care (BCSC) Director, and Provider Network Specialist, the Provider Network Assistant is responsible for assisting with, and maintaining, BCSC provider and vendor contracts, addressing provider and vendor customer service issues and maintaining the provider/vendor database.
- Assist with the initiation, management, and renewal of BCSC provider and vendor contracts assigned by the BCSC Director.
- Ensures contracts comply with federal, state, and local authorities and regulators.
- Stays abreast of federal, state, local and private reimbursement schedules applicable to assigned categories of
- BCSC providers.
- Ensures feedback mechanism and coordination of information for provider credentialing results with the Provider Network Specialist.
- Maintains and updates the provider/vendor database accurately and in a timely fashion.
- Reviews all questionable claims, discusses with Provider Network Specialist and resolves them quickly by coordinating with necessary BCSC personnel and provider.
- Interacts with other BCSC and Los Angeles Jewish Home (LAJH) departments to answer provider questions and
- resolve provider problems, including claims related problems.
- Stays abreast of all federal, state, local and private reimbursement schedules applicable to categories of BCSC
- providers’ claims.
- Ensures that providers maintain a solid working knowledge of BCSC’s Provider Dispute Resolution procedures.
- Maintains BCSC’s Provider Manual, as assigned.
- Participates in BCSC meetings assists marketing on community outreach and enrollment and on community health-related projects as needed.
- Assists with regulatory audit preparation and ensures readiness
- Assist with completion of required internal audit completion.
- Assists in the development of written material for the provider newsletter and other publications deemed
- Complies with safety policies and procedures, identifying and immediately reporting any potential or actual unsafe
- acts or conditions to the Executive Director. Takes necessary measures to ensure a safe environment for oneself,
- co-workers, contractors, participants, visitors and others.
- Consistently meets or exceeds BCSC targets for productivity.
- Continually seeks better ways for delivering services and communicating with participants.
- Consistently meets or exceeds BCSC customer service targets.
- Demonstrates respect for and promotes participant rights, including dignity, self-determination, access to care,
- confidentiality and independence.
- Understands the importance of community involvement and participates as appropriate in activities that link BCSC
- to its communities.
- Effectively collaborates with staff peers and contractors to meet BCSC goals and further success.
- Complies with all policy and procedures of BCSC.
Education and Experience:
- Degree and Diplomas: Bachelor’s Degree in any field or equivalent experience preferred.
- Experience: Two to three years working in a provider relations or a customer service environment.
- Skills/Aptitudes: Effective communication skills, both written and verbal. Computer literacy, especially Microsoft Office products. Accuracy, attention to detail and consistent follow through. Willingness to work with an Interdisciplinary Team. Sensitivity to the health beliefs and needs of a multi-ethnic aged population.