Provider Network Specialist Intern

Why This Role Is Important To Us

Commonwealth Care Alliance (CCA) is thrilled once again to host its Summer Internship Program for clinical and non-clinical departments!The Internship Program is open to undergraduate and graduate students from across the country. CCA Internships are a valuable way for students to obtain real-world experience, gain exposure to a specific field, build their network for the future, and support our members and communities. This program is a great way for CCA to attract and develop exceptional talent as we continue to grow.

This role will report to the Sr. Director of Network Operations and be responsible for various network operations administrative functions. The Network Specialist is responsible for the coordination, administrative, technical, and compliance duties, and ongoing maintenance for all plan providers, medical groups, and Independent Physician Associations (IPAs), hospitals and/or ancillary providers.

The Network Specialist will also be responsible for initial intake and assessment for both incoming routine and complex issues for all participating providers, medical groups, and IPAs, and for various activities related to provider data management and regulatory compliance.

What You'll Be Doing

Administrative communication with CCA care providers, medical groups, and IPAsData Management and entry activities, including:Initial intake and assessment for both incoming routine and complex issues for all participating providers, medical groups, and IPAs, and for various activities related to provider data management and regulatory compliance.Maintain provider rosters, including all direct contract and IPA delegated rostersSubmission of data adds, terms, and changes through various data warehouse systems for network inclusion.Perform quality review and reconciliation of provider data, which includes core system configuration and internal provider database filesAssist with provider network validations and directory reviewsProvide Health Plan updates as necessary to all participating providers, PPGs, and IPAs via phone, fax, email, or other approved form of communicationResponsible for answering and responding to calls, emails, and all other requests in order to resolve inquiries and issues by identifying the topic and type of assistance needed for plan participating providers, PPGs, and IPAsDocument provider requests accurately and clearly, and monitor open service requests to ensure timely responses and closureCollaborate and work with appropriate departments as needed in order to complete assigned projects and resolve provider related issues.Provide weekly production report to the Sr. Director of Network OperationsMaintain health plan confidentiality and compliance with all applicable laws and regulationsUnderstand and abide by all department policies and procedures including organization's Code of Conduct and Compliance programsPerform other duties as assigned by the Sr. Director of Network Operations

Additional Information

Remote (Must be located in California)All internships will be paid standard and competitive rates for undergraduate and graduate levels ($23 and $25 per hour respectively). Internships are expected to be full-time through the duration of the program.

Required

What We're Looking For:

Undergraduate student currently enrolled or a recent graduate within the last 2 years

OR

Graduate student currently enrolled or a recent graduate within the last 2 yearsData Entry10-KeyMicrosoft Suite (Excel and Word)Ability to make decisions, take actions, and follow tasks to completionAbility to communicate effectively (oral and written) with multiple levels of personnel Self-motivated to identify operational issues and make recommendations to resolve issuesStrong problem solving and analytical skillsStrong organizational skills with the ability to plan, prioritize and multi-taskAbility to work in a fast-paced environment with minimal supervisionAbility to handle multiple projects and prioritize workflow

Desired

Minimum 1 year experience in a healthcare setting working administratively with care providers, orMinimum 1 year experience of Data EntryVietnamese, Chinese, or Spanish