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Provider Network Specialist

2 months ago

Albuquerque, New Mexico, United States HireOps Staffing LLC Full time
Job Summary

This is a long-term temporary assignment as a Provider Network Consultant with HireOps Staffing LLC. The successful candidate will be responsible for analyzing and applying business rules to complete requests from providers regarding adds, deletes, and changes to their information used for claims processing, membership assignment, and directory purposes.

Key Responsibilities
  • Analyze and research business rules to complete requests from providers
  • Contract, credential, and maintain facility and professional provider data to support marketing and network contracting
  • Support the implementation of special projects and assist with tracking various phases of a project
  • Manage workflow and assist management in familiarizing and training team members with business rules in network contracting and credentialing
  • Identify gaps in processes and suggest process improvement strategies
Requirements
  • Bachelor's degree plus 1 year of experience with provider network contracting and credentialing systems or 5 years of experience in the healthcare industry
  • Written and verbal communication skills, including interpersonal skills, to develop training materials and act as an advisor to staff
  • Experience and proficiency in Microsoft Office software products, including analytical tools, and experience developing reports
Preferred Qualifications
  • Subject Matter Expert for the Professional Provider Credentialing Process
  • 2 years of experience with current government-sponsored health insurance networks
  • Knowledge of healthcare delivery systems, claim costing analytics, and provider network adequacy analytics