Senior Provider Engagement Network Specialist
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Job Description
Provider Engagement Network Specialist ensuring accurate provider data and resolving issues for health network. Collaborating with providers in managed healthcare settings to maintain effective relationships.
Responsibilities:
- Perform day to day duties of assuring that providers are set up accurately in the provider information system
- Responsible for multiple state deliverables
- network reporting and directories
- claims payment resolution as it relates to provider set up
- Provide support to external provider representatives to resolve provider data issues
- Research and effectively respond to provider related issues
- Act as the internal and external liaison for provider networking
- Maintain positive working relationships with participating physicians, PPG’s, multi-specialty groups, and/or ancillary providers within assigned area
- Act as account manager for assigned groups
- Responsible for daily administration and operation of the contractual provider relationships
- Overseeing accurate and current provider databases
- providing training, education and information to providers
- Research, analyze and resolve complex problems dealing with contract loading
- Serve as primary point of contact and liaison between assigned providers and the health plan
- Provide issue resolution support for most complex provider contracts
Requirements:
- Bachelor’s degree in healthcare related field or equivalent experience required
- 5+ years of provider services experience required
- experience in a managed health care environment
- exposure to provider contracting
- servicing benefits interpretation
- internal operations of provider relations
Benefits:
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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