Senior Provider Engagement Network Specialist

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

📋 Description

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

• Oversee various state deliverables, network reporting, and directories.

• Address claims payment discrepancies related to provider setup.

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

• Investigate and respond to provider-related inquiries.

• Act as a liaison for provider networking with physicians, physician groups, multi-specialty groups, and ancillary providers.

• Manage assigned provider groups and oversee interactions with internal departments.

• Administer contractual relationships with providers and ensure the accuracy of provider databases.

• Deliver training, education, and information to providers.

• Conduct research, analysis, and resolution of complex contract, financial responsibility, rate, language, appeals, grievances, and eligibility issues.

• Serve as the main liaison between assigned providers and the health plan.

• Provide support for issue resolution concerning complex provider contracts, claims, and data issues.

• Act as the subject matter expert for the department.

• Perform other duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Candidates must reside in Ohio.

• 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 in a managed healthcare environment is essential.

• Familiarity with provider contracting is preferred.

• Knowledge of benefits interpretation services is advantageous.

• Understanding of internal operations related to provider relations is beneficial.

• Experience with contract loading is necessary.

• Ability to interpret division of financial responsibility is required.

• Proficiency in interpreting contract rates and language is expected.

• Experience managing appeals, grievances, and eligibility issues is essential.

• Capability to research, analyze, and resolve intricate provider contract, claims, and data issues is required.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in total compensation.

• An equal opportunity employer committed to diversity.