Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Department: Provider Network
Reports to: Provider Network Team Lead
Interrelationships: Operations, Billing
Job Functions and Responsibilities
Qualifications
· High school education, bachelor's degree preferred
· Previous experience in vendor management preferred
· Data entry and customer service experience necessary
Daily Responsibilities
· Recruit, credential, and onboard new providers into the network
· Process contract renewals and ensure all necessary fields are complete for providers’ profiles
· Monitor designated personal and Compliance inbox
· Tasks as assigned by Team Lead
· Leave detailed notes on every assignment plan opened to relay what was done and/or who was contacted
· Answer incoming phone calls professionally and direct them to another department or person if needed
· Do not hesitate to ask for guidance or assistance
· Compile a shift report at the end of the shift and submit to the appropriate Slack channel so that leads and the next shift understand where assignments were left off
Peripheral Responsibilities
· Communicate with Operations to locate potential new providers for assignments that need additional attention
· Monitor Slack channels
Continuous Improvement
· Become familiar with language groups and nuances within dialects that are spoken in the United States.
· Become familiar with United States geography, particularly in the states with high concentration of service requests.
· Become familiar with regulations regarding interpreting certification needs in different states
Miscellaneous Projects
· Occasional tasks or projects that are requested outside the current scope of the position
Job Type: Full-time
Benefits:
Schedule:
Ability to Relocate:
Work Location: In person
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