Healthcare Network Specialist

1 day ago


Tulsa, Oklahoma, United States w3r Consulting Full time
Job Summary

This role is responsible for analyzing and applying business rules to complete requests from providers regarding adds/deletes/changes to their information used for claims processing, membership assignment, and directory purposes.

Key Responsibilities
  • Contracting and credentialing of facilities and professionals to support marketing, network contracting across all lines of business.
  • Supporting the implementation of special projects, tracking various phases of a project, and managing workflow.
  • Assisting management in familiarizing and training team members with business rules in network contracting and credentialing.
  • Identifying gaps in processes and suggesting 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.
  • Strong written and verbal communication skills, including interpersonal skills, to develop training materials and advise staff.
  • Experience and proficiency in Microsoft Office software products, including analytical tools, and 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.


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