Liza Chavez

The Coordinator, Network Management is responsible for working as the internal liaison in maintaining, processing and reviewing department databases and reporting on a daily basis to assist the Network Management Department in meeting the overall network growth and development goals.

· Assist in Network growth and development to include preparation of contract packets for recruitment projects.

· Responsible to work with Network Managers and providers to obtain proper signatures and documentation to effectively process newly recruited or existing providers.

· Maintaining and updating the appropriate databases and department tools with statuses.

· Coordinate receipt and processing of all provider contracts, credentialing, and correspondence.

· Responsible for timely and accurate completion of PACF’s related to incoming documentation received from providers regarding changes to their demographic information in the credentialing and provider network databases.

· Responsible for initial review of all credentialing applications prior to submittal to RMG Contracts for completion and accuracy.

· Working collaboratively with Network Managers during the contracting process to ensure department goals and requirements are being met.

· Responsible for the initial submittal of provider profiles to the Health Plans and follow-up (as requested) to ensure PCP’s are active in databases.

· Limited contract negotiations under the direction of the Director, Network Management and/or Vice President of Regional Operations.

· Daily interaction with regional providers.

· Ensure contract compliance and adherence to DMHC, DHS, CMS and other regulatory agencies as required by contracting HMOs.

· Internal network liaison for Database, Claims, Customer Service, Medical Management, and Provider Relation Departments.

· Perform on-site visits (as required) to physicians, physician groups, hospitals and ancillary providers.

· Facilitate the scheduling of meetings with providers.

· Oversight of database maintenance and accuracy through use of audits.

· Ensure accurate and timely data reporting requirements are being met.

· Know and follow the Employee Handbook policies and procedures.

· Maintain patient confidentiality so that HIPPAA compliance is observed at all times.

· All other duties as directed by management.

Distribution of work:

· Daily production will vary from day to day. All assigned work must be completed by the end of business day in order to maintain turnaround time compliance.

Special Projects:

· Assist with any special projects.