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Medical Network Support Representative
2 months ago
**Job Summary:**
The Provider Network Development Specialist is an entry-level training position aimed at developing proficiency in provider support and network management. This role focuses on learning to address practitioner issues, assist in training and policy education, and maintain accurate reporting and databases. The incumbent will support provider relations, contribute to resolving systemic issues, and ensure compliance with company policies.
**Key Responsibilities:**
- **Assist in Resolving Issues:**
- Help resolve issues related to claims, pricing, and contracts for practitioners, ensuring understanding and effective network operations.
- Support training and policy education for provider staff, including developing and distributing training materials.
- Compile and submit reports on service, recruiting, and other activities as needed.
- Handle fee requests from providers.
- Develop and maintain databases, reports, and statistical analyses related to managed care networks.
- Aid in resolving systemic problems and claim issues, including researching and reporting problems to management.
- Review and update provider directories for managed care networks.
- Build and maintain relationships with internal departments and external provider contacts to support recruitment, servicing, and retention.
- Process provider change forms and maintain an organized system for tracking changes.
- Prepare provider orientation packets, manuals, and application materials.
- Ensure compliance with HIPAA, diversity principles, corporate integrity, and confidentiality policies.
- Communicate effectively with co-workers, management, and providers, and participate in special projects as needed.
**Job Requirements:**
- **Education and Experience:**
- Bachelor's degree or 4 years of relevant work experience in healthcare or insurance.
- 3 years of experience in network management, credentialing, or customer service.
- Understanding of healthcare contracts, claims processing systems, and reimbursement methods.
- Proficiency in using PCs and generating reports.
- Strong verbal and written communication, teamwork, problem-solving, and organizational skills.
- Ability to meet deadlines and work under pressure.
**Preferred Qualifications:**
- **Knowledge of Healthcare Policies:**
- Knowledge of healthcare policies, products, and procedures.