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)
Under direction of the Provider Information Supervisor, the Provider Enrollment Specialist processes, maintains, and revises all components of the provider information database for all Point32Health products/plans. The candidate is responsible for the integrity of all practitioner information housed in the company's provider data systems and communicates with both internal and external customers by telephone, email, and facsimile and in writing regarding practitioner information. The Specialist has comprehensive knowledge of IPA (Independent Practitioners Affiliations) specifics and is in contact with their counterpart regarding individual providers as well as changes within the IPA organization, working closely with the Contract Administrator to keep our Provider Network current. The Specialist also has knowledge regarding contracts and tax id forms, and many other supporting documents, as well as claims payment and claims forms and is a resource externally for providers and internally for numerous departments such as claims, member services, provider services, network contracting, and others.
Key Responsibilities/Duties - what you will be doing
Qualifications - what you need to perform the job
Education, Certification and Licensure
Experience (minimum years required):
Skill Requirements
Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):
Commitment to Diversity, Equity & Inclusion
Point32Health is committed to making diversity, equity, and inclusion part of everything we do-from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Who We Are
Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities.
This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.
Req ID: R7751
About the Company:
Point32Health
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