Network Integrity Program Coordinator

All Care Health Headquarters, Grants Pass, OR, US
6 days ago

Requisition
Salary Range: $24.00 to $26.00 hourly

The Network Integrity Program Coordinator helps ensure provider network adequacy and compliance with regulatory requirements from the Oregon Health Authority (OHA), Centers for Medicare & Medicaid Services (CMS), and other relevant agencies. The role is responsible for implementing initiatives related to provider network access standards, monitoring network reports and dashboards, and assisting with regulatory audits. By collaborating with internal teams and regulatory agencies, the Program Coordinator works to enhance network adequacy, regulatory compliance, and DSN performance.

• Assist with provider network adequacy audits conducted by OHA, CMS, and other regulatory bodies; ensure compliance with applicable standards.
• Oversee the preparation, submission, and response processes for provider‑related audits, partnering with compliance, legal, and operational teams.
• Monitor regulatory updates and policy changes impacting network adequacy; implement necessary adjustments.
• Deliver precise and timely reports of provider network data to regulatory agencies.
• Collaborate with contracting, credentialing, and provider relations teams to address network gaps and resolve provider issues efficiently.
• Evaluate provider access, geographic distribution, and capacity to identify deficiencies and develop corrective action plans.
• Assess DSN performance metrics; identify areas for improvement and implement corrective actions.
• Ensure DSN compliance with all regulatory requirements, submitting necessary documentation and reports.
• Oversee provider network adequacy reports; ensure accuracy and compliance with regulatory standards.
• Utilize data analytics to assess provider performance, access to care, and DSN effectiveness.
• Maintain punctual, regular, and predictable attendance.
• Multitask and prioritize workload; accept direction respectfully from leadership.
• Complete all required training, including those in Relias Learning Module System (LMS).
• Perform other duties as assigned.

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employees or others. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

High school diploma or general education degree (GED) required.

Two to four years of related experience and/or training in healthcare provider network management, regulatory compliance, and/or data analysis required.

• Familiarity with the healthcare industry.
• Exceptional writing, editing, and proofreading skills.
• Excellent organization and time‑management abilities.
• Advanced computer skills, including proficiency in Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
• Knowledge of and compliance with HIPAA regulations.
• Knowledge of operating systems, programming languages, software programs, networks, and related technologies.
• Strong ability to identify and implement improvement activities, ensuring excellence in execution.
• Expertise in breaking projects into definable and measurable tasks, as well as tracking progress to completion.
• Knowledge of research methodologies and data analysis techniques.
• Proficiency in interpreting data to solve problems and extract new insights.
• Skill in locating and synthesizing information from various sources.
• Knowledge of customer service and service recovery best practices.
• Exceptional customer service skills, including responding appropriately and interacting positively with upset customers.
• Knowledge of project management and/or change management practices.
• Familiarity with training development and adult learning principles.
• Awareness of implicit bias, personal identity, power, and privilege in organizational and systemic contexts.
• Understanding the widespread impact of trauma and integrating trauma‑informed practices into organizational policies and procedures.

• Demonstrate accountability, inspiring trust and confidence from others.
• Work with high…