Perform review and analysis of incoming documents to determine completeness of applications and contractual documents and obtain missing documents for processing• Contract implementation activities, including: documentation of business requirements and formalizing contracting policies and procedures as well as negotiating rates for new providers• Collaborate with various cross-functional teams, vendors and local health plan staff regarding data exchanges • Develops and maintain service relationships with physicians, providers and administrators• Coordinate meetings and track outcomes within the department and other departments within the corporation • Identifying and remediating claims issues• Maintain provider databases

Coordinate reports and data request between Health Net and CalVivaManaged weekly report submissions to CalVivaManaged and coordination of the Kaiser transition process, including application review, policy updates, and associate trainingAssist in preparation of materials and requirements for regulatory auditsAssists with informing management and health plan associates of updates or changes to regulatory requirements. Meeting coordination and tracking for Health Net and CalViva Health Committees and workgroups

Coordination of annual DMHC Timely Access Regulations(TAR) filing components for both Health Net and CalViva Health; ensure timely and accurate completion of filing. Develop and monitoring of access corrective action plans process for CalViva Health Providers, including training of collaborating with Provider Services team to meet project goals.Ongoing monitoring and review relevant state and regulatory documentation to ensure compliance with current regulations for both Health Net and CalViva Health.Support implementation of surveys, communication of results and monitoring of corrective action process as required.

Provided administrative support to Operations, Public Programs, and Quality Improvement departments.Coordinated reports and data request between Health Net and CalViva Health to assist with meeting regulatory and contractual requirements; provided adminsitrative support for various meetings, including Joint Operations Meetings, Management Operations, Appeals and Grievances meetings and the CalViva Health Access Meetings.Managed the weekly all cause readmissions mailings.Managed Kaiser transition process, including application review, associate training, and policy updates

• Perform review and analysis of incoming documents to determine completeness of applications and contractual documents and obtain missing documents for processing• Contract implementation activities, including: documentation of business requirements and formalizing contracting policies and procedures as well as negotiating rates for new providers• Collaborate with various cross-functional teams, vendors and local health plan staff regarding data exchanges • Develops and maintain service relationships with physicians, providers and administrators• Coordinate meetings and track outcomes within the department and other departments within the corporation • Identifying and remediating claims issues• Maintain provider databases• Develop letters of agreement, maintain provider documentation files and periodically perform a financial analysis related to provider contracts.

Accountable for administrative management responsibilities including chart disposition and legal preparation, accounts payable and payroll, patient and vendor account reconciliation, inventory control/supply ordering, OSHA compliance, meeting coordination with internal staff and outside entitiesClinical responsibilities including patient discharge and referral support, coordination with specialists, and assisting with-in office medical procedures

Supervision of four staff members, Including payroll trackingConducted Chart audit preparation and ensure office compliance with OSHA regulationsCoordinated with insurance companies to obtain insurance coverage/benefits, referral authorizations and claim denials