In-House IPA Representative

Summary

Under the general direction of the Provider Network Operations (PNO) – Network Management Supervisor, the In-House IPA Representative serves as the liaison between the IPA clients, IPA client’s contracted providers and health plan(s). They will be responsible for the executing the provider onboarding, update, and termination processes for the MedPOINT Management (MPM) managed client IPAs. The In-House IPA Representative ensures the timely and accurate update of provider information system/database, resolution of providers’ issues, State/health plan reporting, and improving all provider business experiences with their assigned IPA. They will interface with PNO, Credentialing, Utilization Management (UM) and other MedPOINT Management (MPM) departments to facilitate numerous processes, including but not limited to Credentialing assistance, UM coordination, contracting support, health plan communications, and Provider communications.

Duties and Responsibilities:

  • Maintain frequent, timely and productive communication with IPA clients, providers, health centers, and health plans
  • Performs PNO triage function; addresses issues and requests raised/submitted by providers and routes communications to the appropriate teams for successful resolution
  • Assist in research of provider-related issues including demographic information, contracting status, credentialing status, claim issues and status in MPM client database
  • Ensure accuracy among assigned IPA profiles within EZ-CAP database
  • Maintain timely and thorough communication with PNO Rate Configuration and Contracts, Credentialing and Compliance Teams on terminations and contract status changes for appropriate rate adjustments and recruitment, if needed
  • Complete/Oversee special projects as they arise (e.g. ad-hoc health plan, IPA clients or provider requests)
  • Participate in assigned IPA client’s standing and ad-hoc meetings as needed
  • Ensure HIPAA compliance is always observed/performed
  • Understand and follow the MPM Employee Handbook policies and procedures
  • Perform additional duties/assignments as needed

Minimum Job Requirements:

  • High School Diploma or GED required, Bachelor’s degree in healthcare or related field preferred
  • 2+ years Managed Care or Healthcare experience in Provider Network Management, a plus
  • Thorough understanding of provider network management processes
  • EZ-CAP knowledge and experience required
  • Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

Knowledge, Skills and Abilities Required:

  • Strong and consistent customer service acumen with the ability to resolve complaints and concerns
  • Excellent attention to detail, with the ability to communicate and document information accurately
  • Ability to multi-task, exercise excellent time management, and meet multiple deadlines
  • Willingness take on and lead projects outside the normal scope of the job description
  • Ability to provide and receive constructive job-related feedback
  • Proven ability to effectively analyze information and think critically
  • Ability to quickly learn and use new software tools
  • Demonstrate commitment to the organization’s core values

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