MSO Compliance & Network Coordinator, FT Days

MSO Compliance & Network Coordinator, FT Days

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 (physician) 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, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation's top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.

The MSO Compliance & Network Coordinator is responsible for 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.

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 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.

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.

Minimum Salary : $30.25

Maximum Salary : $49.94