The government authority in Sacramento, California seeks a qualified vendor to provide comprehensive administrative management and organizational services to support a network of healthcare service providers within the Healthy Partners Program.

Key responsibilities include the development and management of a contracted provider network, with strong focus on provider relations to ensure effective engagement, onboarding, and issue resolution. The vendor will administer healthcare claims, including claims processing, verification, and advising on usual and customary medical provider reimbursement rates.

The provider must also maintain an electronic, HIPAA-compliant portal for the submission of claims and support appeals, exception management, and the escalation of unresolved issues to the County. Additionally, the vendor is expected to develop and maintain a provider network for diagnostic and specialty care, as well as create and operate an electronic authorization and referral system that complies with HIPAA and HI-TECH Act standards.