Provider Network Support Specialist II

Role Overview

• Perform day to day duties of assuring that providers (individual, group, ancillary, etc.) are set up accurately in the provider information system for state reporting, claims payment, and directories
• Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up
• Provide support to the external provider representative to resolve provider data issues
• Research and effectively respond to provider related issues
• Submit provider data entries to resolve provider-related demographic information changes
• Initiate and process provider add, change and termination forms
• Create and maintain spreadsheets used to produce provider directories for multiple products
• Track, update and audit provider data
• Identify adds, deletes and updates to key provider groups and model contracts
• Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment
• Provide assistance to providers with website registration
• Facilitate provider education via webinar
• Work with other departments on cross functional tasks and projects
• Facilitate new provider orientations
• Facilitate provider trainings
• Act as liaison for small PCP groups (as designated by departmental leadership)
• Coaches new hires and less experienced Internal Reps
• Completes special projects as assigned

Requirements

• Associates degree and claims processing, billing and/or coding experience preferred
• Five + years of experience in managed care environment, medical provider office, customer service within a healthcare organization, and medical claims
• Knowledge of health care, managed care, Medicare or Medicaid

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