Provider Network Specialist
3 weeks ago
This role involves 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.
The position is responsible for contracting, credentialing, and maintaining Facility/Professional provider data to support marketing, network contracting across all lines of business.
This role requires supporting the implementation of special projects, assisting with tracking of various phases of a project, and managing workflow.
The position includes assisting management in familiarizing and training team members with the various business rules in network contracting and credentialing across all lines of business.
In addition, this role is responsible for identifying gaps in processes and suggesting process improvement strategies.
Key Responsibilities- Contracting and credentialing of providers
- Maintenance of provider data
- Supporting special projects
- Training and familiarization of team members
- Process improvement strategies
- Bachelor degree plus 1 year of experience with Provider Network contracting and credentialing systems OR 5 years of experience in the Health Care industry
- Written and verbal communication skills including interpersonal skills
- Experience and proficiency in Microsoft Office software products including analytical tools
- 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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