Medical Provider Network Relations II

About the position

The position is focused on the frontline of Network Development, where the individual will provide excellent customer service while overseeing provider data integrity. This remote role requires strong interpersonal skills and knowledge of the medical provider market to effectively manage provider relationships and ensure compliance with credentialing requirements.

Responsibilities

• Assist Developer with implementing medical providers through correspondence and telephonic contact.
• Verify all provider signatures, contracts, and documentation before submitting for internal processing.
• Review credentials of prospective providers for acceptance into the network per national credentialing requirements and protocols.
• Provide orientation on managed care procedures and establish liaison(s) with all participating providers.
• Assist and communicate a provider orientation program in cooperation with Developer.
• Distribute and maintain provider manual and orientation materials per state guidelines.
• Receive and resolve all disputes involving provider contract and payment issues in accordance with contract Dispute Resolution Procedures.
• Provide assistance and be responsive to staff requests for assistance and information regarding the network, both locally and nationally.
• Oversee distribution of executed contracts and maintenance of 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 Developer.
• Maintain a professional appearance and regular attendance.

Requirements

• Associate's degree or two or more years equivalent work experience.
• Proficient in Microsoft applications.
• Customer service education/training within the insurance industry, managed care, or related field.

Nice-to-haves

• Strong interpersonal skills and adaptive communication style.
• Complex problem-solving skills and drive for results.
• Ability to adapt daily routines to manage functions effectively.
• Ability to prioritize and manage assignments, both scheduled and unscheduled.
• Embrace new tools and procedures per corporate guidelines and objectives.
• Strong organizational skills.
• Excellent written and verbal communication skills.
• Superb attention to detail and ability to deliver results in a fast-paced environment.

Benefits

• Medical (HDHP) with Pharmacy
• 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
• 401K
• ROTH 401K
• Paid time off