Provider Engagement Network Specialist

This is a fully remote position, open to applicants in Florida, +5 more states.

📋 Description

• Ensure that providers are accurately entered into the provider information system for state reporting, claims payment, and directory listings.

• Assist external provider representatives in addressing provider data discrepancies.

• Investigate and respond to issues related to providers.

• Process provider data entries for changes in demographic information.

• Initiate and manage provider addition, modification, and termination forms.

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

• Monitor, update, and audit provider information.

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

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

• Aid providers in the registration process on the website.

• Conduct provider education sessions via webinars.

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

• Organize new provider orientations and training sessions.

• Carry out additional tasks as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• 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 health care, managed care, Medicare, or Medicaid.

• Must be available to work during Eastern Standard Time zone business hours.

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

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in the overall compensation package.

• An equal opportunity employer dedicated to diversity.