Provider Engagement Network Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Ensure that providers are accurately configured in the provider information system for state reporting, claims payment, and directories.

• Assist external provider representatives in resolving issues related to provider data.

• Investigate and address provider-related concerns.

• Process submissions for provider demographic information updates.

• Initiate and handle provider addition, change, and termination forms.

• Develop and maintain spreadsheets for provider directories across various products.

• Monitor, update, and audit provider information.

• Identify necessary additions, deletions, and updates to essential provider groups and model contracts.

• Investigate inaccuracies in claim-payment processing and direct them to the appropriate site operations team for corrections.

• Assist providers with the registration process on the website.

• Conduct provider education sessions via webinars.

• Collaborate with other departments on cross-functional tasks and initiatives.

• Organize new provider orientations and training sessions.

• Carry out additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Applicants must reside in Florida.

• An associate's degree along with experience in claims processing, billing, and/or coding is preferred.

• A minimum of three years of experience in a managed care setting, medical provider office, customer service within a healthcare organization, and medical claims.

• Familiarity with healthcare, managed care, Medicare, or Medicaid.

• Capability to support areas in South Florida: Miami, Broward, Palm Beach.

• Qualified candidates with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off along with holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in the total compensation package.

• Competitive salary.