IPA Operations Manager - Inland Empire

$88,000 - $173,200/Yr

Optum - Ontario, CA

Full-time

Ontario, CA

Insurance Carriers and Related Activities

About the position

The IPA Operations Manager will serve as the primary point of contact and central resource for the IPA provider network, responsible for providing exceptional service to healthcare providers. This role involves educating providers on IPA policies, managing key performance initiatives, coordinating operational processes, and addressing any issues or concerns. The position also includes fulfilling administrative duties and driving marketing and business development efforts to strengthen the network in response to the growing healthcare needs of the market.

Responsibilities

• Develop and maintain strong relationships with network providers to ensure high-quality service delivery and promote IPA growth
• Network expansion focusing on new PCP/SPC recruitment for identified geographic areas
• Collaborate with providers to ensure understanding of IPA policies, procedures, and guidelines
• Assist providers with claim submission and payment processes, including understanding coding and billing guidelines
• Respond promptly to provider inquiries and concerns, escalating issues to appropriate parties as needed
• Ensure all provider-related data is accurate and up to date in IPA databases and systems
• Collaborate with internal teams to facilitate timely and effective resolution of provider issues
• Participate in training and education sessions to develop and maintain a deep understanding of healthcare industry trends, regulations, and compliance requirements
• Identify opportunities to improve IPA processes and procedures to better support our network of providers
• Submit/process Contract Request for PCP & Specialists including but not limited to amendment/transmittal
• Serve as liaison with Health plans related to member eligibility, member issues, and provider related inquiries
• Assist IPA with Specialty contracts discussions, negotiations and onboarding of new Specialty groups
• Coordinate, track and support deployment of new PCP onboarding (systems, access, office readiness)
• Collaborate on updates, tracking and deployment of PCP variable comp dashboards, and Annual notices, renewals/Smart sheets updates, and follow up
• Monthly Specialties Cap Split report calculations
• Assist with annual tabulations of PCP and Specialty incentive programs results
• Distribution of PCP & Specialty CAP Report/Pre-Cap Summaries to providers
• Participate in IPA FISH/UM review and communicate updates accordingly
• Assist with coordination and tracking of IPA monthly network Cap leakage
• Serve as the primary point of contact and central resource for any Quality, Risk adjustment and growth-related initiatives, questions, or inquiries
• Adhoc duties related to provider and patient care

Requirements

• 2+ years of experience in a network management-related role, such as contracting or provider services
• 2+ years of provider relations or managed care experience
• 2+ years of sales or marketing experience within a matrix organization or experience in a metric/goal driven environment
• Provider recruitment and contracting experience
• Experience working with diverse patient populations
• Experience outreaching to prospective patients and providers
• Experience presenting materials to clients internal or external
• Experience working with a wide range of people including physicians, patients, office staff, hospital executives, and other health plan staff
• Willingness to travel regularly (locally within the Inland Empire) up to 75% of the time

Benefits

• 401(k) matching
• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase