PIH Health Hospital
MSO Compliance & Network Coordinator, FT Days
PIH Health Hospital, Whittier, California, us, 90607
Overview
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
Responsibilities
Assist with compliance and audit functions of PHP/MSO (Management Services Organization), including internal and external audit activities to the Claims, UM, Credentialing, CM functions, and quality improvement initiatives.
Monitor regulatory requirements and understand how requirements impact MSO operations.
Efficiently manage the workflow of policies and procedures, ensure deadlines are met, upload documents, and conduct follow-up reporting.
Generate and review policies for MSO and manage storage and handling of all policy documentation.
Ensure all IPA network provider additions, changes, and deletions are timely communicated and correctly reflected by the PHP network and contracted health plans.
Maintain the integrity of the provider management elements loaded in managed care application databases/software.
Triaging all general provider relations issues and address as necessary.
Partner with other PHP departments and work on special projects as assigned.
Required Skills
Strong communication skills, verbal, non-verbal, written, and oral.
Excellent interpersonal skills with the ability to interact and work effectively with internal and external departments, 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.
Required Experience
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.
Preferred
Familiar with Medicare and MediCal programs.
Familiarity with ICD-9, ICD-10, CPT-4, and HCPCS coding.
One to two years of experience in Compliance and Contracts Management.
Details
Address : 6557 Greenleaf Ave.
Salary : 30.25-49.94
Shift : Days
Zip Code : 90601
#J-18808-Ljbffr
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
Responsibilities
Assist with compliance and audit functions of PHP/MSO (Management Services Organization), including internal and external audit activities to the Claims, UM, Credentialing, CM functions, and quality improvement initiatives.
Monitor regulatory requirements and understand how requirements impact MSO operations.
Efficiently manage the workflow of policies and procedures, ensure deadlines are met, upload documents, and conduct follow-up reporting.
Generate and review policies for MSO and manage storage and handling of all policy documentation.
Ensure all IPA network provider additions, changes, and deletions are timely communicated and correctly reflected by the PHP network and contracted health plans.
Maintain the integrity of the provider management elements loaded in managed care application databases/software.
Triaging all general provider relations issues and address as necessary.
Partner with other PHP departments and work on special projects as assigned.
Required Skills
Strong communication skills, verbal, non-verbal, written, and oral.
Excellent interpersonal skills with the ability to interact and work effectively with internal and external departments, 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.
Required Experience
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.
Preferred
Familiar with Medicare and MediCal programs.
Familiarity with ICD-9, ICD-10, CPT-4, and HCPCS coding.
One to two years of experience in Compliance and Contracts Management.
Details
Address : 6557 Greenleaf Ave.
Salary : 30.25-49.94
Shift : Days
Zip Code : 90601
#J-18808-Ljbffr