In-House IPA Representative (Hybrid)

MedPOINT Management; Los Angeles (CA); Hybrid; USD 32,000 - 37,000; Full time

Job summary

MedPOINT Management in Los Angeles, CA, seeks an In-House IPA Representative to serve as liaison between IPA clients, providers, and health plans. You will manage provider onboarding, updates, and terminations for MedPOINT’s managed client IPAs, ensuring accurate data in EZ-CAP and timely resolution of issues.

This role requires strong communication, HIPAA compliance, and experience in managed care. Duties include triage of provider inquiries, coordination with Credentialing and Compliance

Qualifications

• High School Diploma or GED required; Bachelor's degree preferred in healthcare or related field.
• Experience in managed care or healthcare provider network management is a plus.
• Familiarity with EZ-CAP database and Microsoft Office Suite is preferred.

Responsibilities

• Maintain frequent, timely, and productive communication with IPA clients, providers, health centers, and health plans.
• Perform PNO triage; address issues and route to appropriate teams for resolution.
• Assist in researching provider-related issues including demographics, contracting, credentialing, and claim status in the client database.
• Ensure accuracy among IPA profiles within EZ-CAP database.
• Communicate with Rate Configuration, Contracts, Credentialing, and Compliance teams on terminations and contract changes for rate adjustments and recruitment.
• Participate in ad-hoc projects as they arise and in standing meetings with IPA clients.
• Ensure HIPAA compliance is observed/performed.

Skills

Customer service

Attention to detail

Time management

Multitasking

Communication

Analytical thinking

Learning new software

Education

High School Diploma or GED

Bachelor’s degree in healthcare or related field preferred

Tools

EZ-CAP

Microsoft Office Suite

Job description

Under the general direction of the Provider Network Operations (PNO) – Provider 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:

• Maintainfrequent,timelyandproductivecommunicationwithIPAclients,providers,healthcenters,andhealthplans
• 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
• EnsureaccuracyamongassignedIPAprofileswithinEZ-CAPdatabase
• MaintaintimelyandthoroughcommunicationwithPNORateConfiguration andContracts,CredentialingandComplianceTeams on terminations and contract status changes for appropriate rate adjustments and recruitment, if needed
• Complete/Overseespecialprojectsastheyarise(e.g.ad-hochealthplan,IPAclientsorproviderrequests)
• ParticipateinassignedIPAclient’sstandingandad-hocmeetingsasneeded
• EnsureHIPAAcomplianceisalways observed/performed
• UnderstandandfollowtheMPMEmployeeHandbookpoliciesandprocedures
• Performadditionalduties/assignmentsasneeded
• HighSchoolDiplomaorGEDrequired,Bachelor’sdegreeinhealthcareorrelatedfieldpreferred
• 2+yearsManagedCareorHealthcareexperienceinProviderNetworkManagement,aplus
• Thoroughunderstandingofprovidernetworkmanagementprocesses
• EZ-CAPknowledgeandexperiencerequired
• ProficientinMicrosoftOfficeSuite(Word,Excel,PowerPoint,Outlook)

Skills and Abilities:

• Strongandconsistentcustomerserviceacumenwiththeabilitytoresolvecomplaintsandconcerns
• Excellentattentiontodetail,withtheabilitytocommunicateanddocumentinformationaccurately
• Abilitytomulti-task,exerciseexcellenttimemanagement,andmeetmultiple deadlines
• Willingnesstakeonandleadprojectsoutsidethenormalscopeofthejobdescription
• Abilitytoprovideandreceiveconstructivejob-relatedfeedback
• Provenabilitytoeffectivelyanalyzeinformationandthinkcritically
• Abilitytoquicklylearnandusenewsoftwaretools
• Demonstratecommitmenttotheorganization’scorevalues

Salary Range:

• $23 – $27 hourly

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