Senior 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 compliance, claims reimbursement, and directories.

• Oversee various state deliverables, network reports, directories, and the resolution of claims payments related to provider setup.

• Assist external provider representatives in addressing provider data discrepancies.

• Investigate and respond efficiently to provider-related inquiries.

• Serve as a liaison for both internal and external provider networking.

• Foster and maintain collaborative relationships with participating physicians, physician groups, multi-specialty groups, and ancillary providers.

• Function as the account manager and gatekeeper for designated provider groups.

• Manage and operate contractual relationships with providers.

• Ensure the accuracy and currency of provider databases.

• Offer training, education, and relevant information to providers.

• Research, analyze, and resolve intricate issues related to contract loading, interpretation of financial responsibilities, contract terms and language, appeals, grievances, and eligibility.

• Act as the main point of contact between assigned providers and the health plan.

• Address intricate provider contract, claims, and data challenges.

• Serve as the department's subject matter expert.

• Perform additional duties as assigned.

• Adhere to all company policies and standards.

⛳️ Requirements

• Must be eligible to work in the U.S. without requiring employment-based visa sponsorship, now or in the future.

• A Bachelor’s degree in a healthcare-related field or equivalent experience is required.

• A minimum of 5 years of experience in provider services is required.

• Experience within a managed healthcare setting is essential.

• Familiarity with provider contracting, benefits interpretation, and the internal operations of provider relations is preferred.

• Proficiency with provider information systems, provider databases, state reporting, claims payment, directories, contract loading, financial responsibility interpretation, contract rates and language, appeals, grievances, and eligibility is necessary.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

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

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

• Equal opportunity employer dedicated to fostering diversity.