Network Provider Relations & Provider Data Specialist
New
You must reside in the US Central or US Eastern regions, US Central or US Eastern regionsFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5+ years
- Required Skills
- Data AnalysisSalesforceMicrosoft Excel
Requirements
- 5+ years of experience negotiating provider contracts.
- Experience with multiple payment methodologies including percent of Medicare, RBRVS, ICD, case rates, DRG, and value-based/risk parameters.
- Experience negotiating with hospital systems and physician groups.
- Analytic capabilities including experience with SERFF reporting.
- Experience with Salesforce or similar CRM.
- Experience working in a virtual environment.
- Advanced MS Excel skills.
- Ability to handle large data files.
- Experience reconciling provider roster data and validating directories.
- Strong verbal and written communication skills.
- Experience and relationships in the Texas provider community.
Responsibilities
- Communicate with providers regarding claims, service issues, and complaints.
- Develop an adequate provider network in assigned geographical areas.
- Collect and standardize provider roster updates with Analytics and IT.
- Track and coordinate effective dates with the credentialing CVO.
- Manage network according to regulatory time, distance, and choice requirements.
- Build and maintain relationships with contracted providers.
- Monitor reports to ensure compliance and identify gaps.
- Maintain contract tracking data in Salesforce.
- Report status, risks, and opportunities to leadership.
- Collaborate on medical economics reporting and fee schedule benchmarking.
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