Senior Provider Engagement Network Specialist

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

📋 Description

• Ensure that providers are accurately set up in the provider information system for state reporting, claims processing, and directories.

• Oversee state deliverables, network reporting, directories, and the resolution of claims payment issues related to provider setup.

• Assist external provider representatives in addressing provider data challenges.

• Investigate and address provider-related inquiries.

• Serve as a liaison for provider networking both internally and externally.

• Cultivate relationships with participating physicians, physician groups, multi-specialty groups, and ancillary providers.

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

• Manage contractual provider relationships and ensure the accuracy of provider databases.

• Offer training, education, and resources to providers.

• Research, analyze, and resolve intricate issues related to contracts, claims, eligibility, appeals, grievances, and provider data.

• Act as the primary liaison between assigned providers and the health plan.

• Serve as the department's subject matter expert.

• Carry out additional duties as assigned while adhering to policies and standards.

⛳️ Requirements

• Residency in New Jersey is required.

• Must have authorization to work in the U.S. without the need for 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 necessary.

• Experience in a managed healthcare setting is essential.

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

• Proficiency with provider information systems, provider data management, contract loading, contract rates and language, as well as appeals, grievances, eligibility, claims, and data issue resolution is needed.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plan.

• Tuition reimbursement assistance.

• Paid time off, including holidays.

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

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