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)
Position Description: Paralegal - Health Insurance Specialist
Under the direction of the Independent Dispute Resolution Entity (IDRE) Stakeholder Engagement Subject Matter Expert or his/her designee, the Paralegal - Health Insurance Specialist applies critical thinking skills, IDRE program policies and regulatory guidance to analyze and adjudicate payment determination disputes between nonparticipating providers, nonparticipating emergency facilities or nonparticipating providers of air ambulance services and a group health plan. The Paralegal - Health Insurance Specialist reviews all documentation received from the involved parties in regard to their proposed payment amount and renders an independent determination, selecting one of the two proposed offers, based upon the credible facts presented. The Paralegal ? Health Insurance Specialist will specialize in processing bifurcated state disputes and will complete research on state laws in support of attorneys as requested/required. .In addition to review, the Health Insurance Specialist completes all case related documentation and sends appropriate email notification as per the established workflow. They are also responsible for timely and accurate case specific data entry into the government portal.
Responsibilities:
Clear All
0 Provider Network Specialist jobs found in El Paso, TX area