Top 93 Provider network coordinator Jobs in San Francisco, Ca

PROVIDER NETWORK COORDINATOR
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $39.69 - $45.10 an hour
- Full-time
- Microsoft Outlook
- Computer literacy
- Bachelor of Science
- Health insurance
- Dental insurance
Network Development Coordinator
Altais Health Solutions —Oakland, CA
- $56,925 - $74,520 a year
- Full-time
- Hybrid work
- Background check
- Marketing
- Pass drug screening
- Paid holidays
- Health insurance
Quick Apply
Resident Health Services Coordinator (San Clemente, Drakes Way - 1338, 1288)
EAH INC. —Corte Madera, CA
- $25 - $37 an hour
- Online Application
- Bilingual
- Background check
- 18 years or older
- Wellness program
- 403(b) matching
Quick Apply
Emergency Medical Technician (EMT) - Alameda County
Royal Ambulance —San Leandro, CA
- $18.50 - $21.00 an hour
- Part-time
- 18 years or older
- CPR Certification
- Current TB test
- Health insurance
- Dental insurance
Quick Apply
Emergency Medical Technician (EMT) - San Francisco (Full Time Only)
Royal Ambulance —Daly City, CA
- $21 - $22 an hour
- Full-time
- 18 years or older
- CPR Certification
- Current TB test
- Health insurance
- Dental insurance
Quick Apply
Organ Recovery Surgeon - National - Traveling - Nationwide
Vituity —Emeryville, CA
- Full-time
- Medicine
- Surgery
- BC/BE
- Health savings account
- AD&D insurance
1d
Resident Services Coordinator (SRO)
Mission Housing Development Corporation —San Francisco, CA
- $29 - $32 an hour
- Full-time
- 18 years or older
- Psychiatry
- Addiction Medicine
Quick Apply
Traffic Coordinator (Bay Area)
Connoisseur Media —San Francisco, CA
- $55,000 - $60,000 a year
- Inventory management
- Word processing
- Mid-level
- AD&D insurance
- Disability insurance
Quick Apply
Care Coordinator
Five Keys Schools and Programs —San Francisco, CA
- $29 - $35 an hour
- Full-time
- Addiction Medicine
- Experience working with individuals with disabilities
- High school diploma or GED
- Health insurance
- Dental insurance
Instructional Media and Studio Coordinator (4505C) #86618
University of California Berkeley —Berkeley, CA
- $46.46 - $50.29 an hour
- Full-time
- Customer service
- Mid-level
- University
Financial Management Services (FMS) Coordinator – California SDP
HR Alliance —San Francisco, CA
- $70,000 - $80,000 a year
- Full-time
- Background check
- Spanish
- Mid-level
Quick Apply
Resident Services Coordinator (Families)
Mission Housing Development Corporation —San Francisco, CA
- $29 - $32 an hour
- Full-time
- Spanish
- Microsoft Outlook
- Management
- Health insurance
- Dental insurance
Quick Apply
Clinical Research Coordinator
University of California San Francisco —San Francisco, CA
- Full-time
- Spanish
- Microsoft Excel
- HIPAA
Financial Management Services (FMS) Coordinator – Self Determination
HR Alliance —San Francisco, CA
- $70,000 - $80,000 a year
- Full-time
- Background check
- Spanish
- Mid-level
Quick Apply
Lead Service Coordinator
SATELLITE AFFORDABLE HOUSING ASSOCIATES —Berkeley, CA
- $34.86 - $38.46 an hour
- Full-time
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Commuter assistance
- Paid holidays
Quick Apply
4d
Program Manager
University of California San Francisco —San Francisco, CA
- Full-time
- Surgery
- Writing skills
- Research
12d
Related Services Billing & Compliance Coordinator
Rocketship Public Schools —San Francisco Bay Area, CA
- $70,304 - $77,760 a year
- Weekends as needed
- Hybrid work
- School experience
- Mid-level
- 3 years
- Health insurance
- Flexible spending account
Quick Apply
Facilities Coordinator
US AMR-Jones Lang LaSalle Americas, Inc. —South San Francisco, CA
- $35 - $45 an hour
- Online Application
- Background check
- Mid-level
- High school diploma or GED
- Paid parental leave
- Paid holidays
Quick Apply
Coordinator - START
YAI - Seeing Beyond Disability —Berkeley, CA
- $80,000 a year
- Weekends as needed
- Experience working with individuals with developmental disabilities
- Writing skills
- HIPAA
Help Me Grow Care Coordinator
Contra Costa Crisis Center —Walnut Creek, CA
- $31 - $34 an hour
- Full-time
- Spanish
- Experience working with individuals with disabilities
- Computer literacy
Quick Apply
4d

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PROVIDER NETWORK COORDINATOR

NORTH EAST MEDICAL SERVICES -
Burlingame, CA

Apply Now

Job Details

Full-time
$39.69 - $45.10 an hour

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance

Qualifications

Microsoft Outlook
Computer literacy
Newsletters (communication methods)

Full Job Description

SUMMARY OF POSITION:

The Provider Network Coordinator (PNC) is responsible for a wide range of activities to support, develop and maintain service relationships with all participants (physicians, hospitals and health systems, providers, and administrators) of the MSO provider network. Primary focus will be on timely completion of provider credentialing and re-credentialing activities, according to Health Plan, State, Federal and NCQA requirements, for over 1,000 network providers. The PNC is responsible managing and maintaining accurate data related to the provider and groups within the MSO provider network. This includes being the main point of contact for all provider information and collaborating with contracted health plans, internal teams and directly with providers to ensure accurate data collection and exchange.

The PNC ensures MSO network providers meet all credentialing and licensing requirements and is responsible for continuous monitoring of the entire provider network. The PNC plays a crucial role in building and sustaining a high-quality provider network by overseeing the data accuracy and credentialing of all healthcare professionals.

ESSENTIAL JOB FUNCTIONS:

Serve as point of contact between NEMS organization, MSO network providers, Health Plansand other community partners to support credentialing and provider data maintenance .
Assist with the development of written communications for general NEMS MSO notifications, provider newsletter, MSO website, and maintaining provider on-line directory and tools/resources.
Responsible for the initial credentialing and re-credentialing activities for new and recertified providers, including licensure verifications, follow up on completion of applications and/or missing/unclear data, according to Health Plan, State, Federal and NCQA requirements.
Responsible for inputting and maintaining credentialing information for physicians and organizations, utilizing monitoring reports to tracking for physicians’ re-credential status, quality assurance information, verification of sanctions, and incident investigation status.
Coordinate and facilitate the NEMS/MSO Credentialing/Privileging Committee meeting and follow up on action requests by the Committee.
Be the point of contact for credentialing denials, provider complaints and/or appeals about credentialing.
Carry out monthly monitoring activities to ensure NEMS MSO network providers are in compliance.
Coordinate with contracted entities for Credentialing sub-delegation ongoing reports, rosters, and monitoring.
Coordinate with contracted Health Plan(s) for annual delegation audits, and any other audits conducted by DHCS/DMHC/CMS as applicable. This includes preparing audit files and universes.
Ensure all NEMS systems containing provider data are accurate and updated accordingly. Also communicate provider changes to other internal teams, as appropriate.
Communicate with contracted Health Plans to report new, updated, or terminated physician and practice information as required per SB137.
Submit accurate and complete provider rosters to contracted health plans based on contractual requirements. Update contracted health plan on provider/adds/terms and changes, as needed, between roster submissions.
Research and understand complex issues raised by physician practices, and/or health plan partners, coordinate with other internal teams for follow up activities and resolution.
Identify and research a variety of issues related to provider credentialing, compliance, and operational issues, utilizing various sources, including but not limited to current contracts, publications, websites, and provider notifications.
Play an active role in supporting new team members and assist with trainings.
Perform other duties as assigned.

BA/BS degree; Associate Degree may be considered with relevant, equivalent work experience.
2-3 years work experience in healthcare setting in the areas of provider relations, claims, or utilization management is preferred.
Knowledge of Medicare and/or Medi-Cal managed care program and/or other state-sponsored program is a plus.
Prior managed care experience with knowledge of CMS/DHCS health policy is a plus.

Superior ability to communicate (spoken and written) effectively with a variety of professionals, including physicians and other healthcare providers, business administrators and contracting managers, billing and revenue cycle agencies.
Must be PC literate - Strong Excel, Word, Power point, and Outlook skills;
Knowledge of community resources and culture is a plus.

Detail-oriented and organized with the ability to interpret DHCS policy letters and make decisions.
Good organization and problem-solving skills.
Ability to self-manage and work with multiple departments within the organization and external clients.

LANGUAGE:

Must be able to fluently speak, read and write English.
Fluent in other languages are an asset.

STATUS:

This is an FLSA NON-exempt position.
This is not an OSHA high-risk position.
This is a Full Time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

Apply Now

Refine Your Search

provider network coordinator jobs in san francisco, ca

PROVIDER NETWORK COORDINATOR

Network Development Coordinator

Resident Health Services Coordinator (San Clemente, Drakes Way - 1338, 1288)

Emergency Medical Technician (EMT) - Alameda County

Emergency Medical Technician (EMT) - San Francisco (Full Time Only)

Organ Recovery Surgeon - National - Traveling - Nationwide

Resident Services Coordinator (SRO)

Traffic Coordinator (Bay Area)

Care Coordinator

Instructional Media and Studio Coordinator (4505C) #86618

Financial Management Services (FMS) Coordinator – California SDP

Resident Services Coordinator (Families)

Clinical Research Coordinator

Financial Management Services (FMS) Coordinator – Self Determination

Lead Service Coordinator

Program Manager

Related Services Billing & Compliance Coordinator

Facilities Coordinator

Coordinator - START

Help Me Grow Care Coordinator

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