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Medical Provider Network Relations Specialist II
2 months ago
At CorVel Healthcare Corporation, we are seeking a highly skilled Medical Provider Network Relations II to join our team. This role is responsible for providing exceptional customer service while ensuring the integrity of provider data.
Key Responsibilities:- Collaborate with the development team to implement medical providers through effective correspondence and telephonic contact.
- Verify provider signatures, contracts, and documentation after submission for internal processing.
- Review credentials of prospective providers to ensure compliance with national credentialing requirements and protocols.
- Provide orientation on managed care procedures and establish liaisons with participating providers.
- Assist in developing and communicating a provider orientation program in cooperation with the development team.
- Distribute and maintain provider manuals and orientation materials in accordance with state guidelines.
- Resolve disputes involving provider contracts and payment issues in accordance with contract dispute resolution procedures.
- Provide assistance and support to staff requests for information regarding the network, both locally and nationally.
- Oversee the distribution of executed contracts and maintenance of the database.
- Assist with network marketing, employer, and payor relations, and product development.
- Conduct and manage provider data audits to ensure data integrity for the network and oversee all provider updates and changes with NDB.
- Coordinate and process provider roster updates at least annually or as otherwise required.
- Perform facility site surveys as needed per credentialing requirements or state guidelines.
- Identify anemic specialties within the network and generate a recruitment list for the development team.
- Associate's degree or two or more years of equivalent work experience.
- Proficient in Microsoft applications.
- Customer service education/training within the insurance industry, managed care, or a related field.
CorVel Healthcare Corporation offers a comprehensive benefits package, including medical, dental, vision, long-term disability, health savings account, flexible spending account options, life insurance, accident insurance, critical illness insurance, pre-paid legal insurance, parking and transit FSA accounts, 401(k), ROTH 401(k), and paid time off.
We are an equal opportunity employer and comply with ADA regulations as applicable.
