Senior Provider Engagement Network Specialist

Role Overview

• Perform day to day duties of assuring that providers are set up accurately in the provider information system
• Responsible for multiple state deliverables
• network reporting and directories
• claims payment resolution as it relates to provider set up
• Provide support to external provider representatives to resolve provider data issues
• Research and effectively respond to provider related issues
• Act as the internal and external liaison for provider networking
• Maintain positive working relationships with participating physicians, PPG’s, multi-specialty groups, and/or ancillary providers within assigned area
• Act as account manager for assigned groups
• Responsible for daily administration and operation of the contractual provider relationships
• Overseeing accurate and current provider databases
• providing training, education and information to providers
• Research, analyze and resolve complex problems dealing with contract loading
• Serve as primary point of contact and liaison between assigned providers and the health plan
• Provide issue resolution support for most complex provider contracts

Requirements

• Bachelor’s degree in healthcare related field or equivalent experience required
• 5+ years of provider services experience required
• experience in a managed health care environment
• exposure to provider contracting
• servicing benefits interpretation
• internal operations of provider relations

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules