Senior Provider Engagement Network Specialist

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

📋 Description

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

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

• Assist external provider representatives in addressing and resolving provider data concerns.

• Investigate and respond to issues pertaining to providers.

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

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

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

• Manage contractual relationships with providers and ensure the provider databases are accurate and up to date.

• Offer training, education, and information to providers.

• Research, analyze, and address complex issues related to contract loading, interpretation of financial responsibilities, contract rates and language, appeals, grievances, and eligibility matters.

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

• Resolve intricate issues involving provider contracts, claims, and data.

• Serve as the department's subject matter expert.

• Carry out other assigned responsibilities.

• Adhere to all policies and standards.

⛳️ Requirements

• Must be legally authorized to work in the U.S. without the need for employment-based visa sponsorship, both now and 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 environment is required.

• Familiarity with provider contracting is preferred.

• Knowledge of benefits interpretation servicing is beneficial.

• Understanding of the internal operations of provider relations is an asset.

• Candidates must reside in Western/Southwestern Pennsylvania.

• Occasional travel for meetings is required.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off.

• Holidays.

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

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

• We are an equal opportunity employer committed to diversity.