Network Operations Specialist

$73,507 - $110,240/Yr

Gold Coast Health Plan - Camarillo, CA

Full-time - Mid Level

Camarillo, CA

About the position

The Network Operations Specialist at Gold Coast Health Plan is responsible for liaising with healthcare providers and clients regarding healthcare-related issues, ensuring compliance with processes, policies, and procedures. This role involves training healthcare providers, resolving queries, and maintaining effective communication to enhance operational efficiency within the organization. The position requires strong organizational and communication skills, with a significant amount of travel expected.

Responsibilities

• Initiating and maintaining effective channels of communication with GCHP network providers.
• Participating in departmental processes to manage GCHP network providers, including preparing presentations and reports for meetings.
• Onboarding new GCHP network providers to ensure compliance with regulatory requirements.
• Investigating contracting questions and interpreting contract language related to provider roles and responsibilities.
• Gathering, reviewing, and verifying information related to GCHP network providers within regulatory timeframes.
• Managing and maintaining GCHP network provider data and rosters, ensuring timely updates.
• Establishing and maintaining relationships with GCHP network providers through various communication methods.
• Participating in training for GCHP network providers on policies, procedures, and technology.
• Answering questions from GCHP providers to drive resolution.
• Gathering and submitting documentation for complex claims inquiries and processing.
• Maintaining understanding of applicable healthcare laws and regulations, focusing on Medicaid and Medicare.
• Notifying colleagues of potential issues and trends in the provider network to initiate improvements.
• Assisting with training on contract inquiries and issues affecting network providers.
• Preparing materials and presentations for meetings.

Requirements

• High School Diploma and 5 years of direct healthcare experience.
• Minimum 5+ years of health care/managed care experience in the healthcare field.
• Advanced computer skills in MS Office products, specifically Word, Excel, PowerPoint, Teams, and Outlook.
• A valid and current Driver's License.

Nice-to-haves

• Bachelor's Degree (four-year college)
• 3+ years of provider relations and/or provider network experience interacting directly with providers.
• Understanding and experience with Governmental Programs (Medicare and Medicaid), with direct experience in California MediCal.

Benefits

• Health insurance
• Flexible schedule