Provider Network Specialist jobs in Morgantown, WV

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)

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Network Provider Contracting Specialist - Peak Health
  • Allied Health Solutions
  • Morgantown, WV FULL_TIME
  • Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position.

    Plays a critical role in developing a network for our members and providers. Reporting to the Manager of Contracting you will be a critical part of the Provider Relations team.

    The ideal candidate for this role is a passionate, community oriented and has direct health plan managed care contracting experience. You have strength in negotiating complex contacts, evaluating competing priorities while staying aligned with organizational goals and strategies. You are technically savvy with a solid understanding of network adequacy requirements and health plan analytics to aid in the contracting process. You are flexible and thrive in a fast-paced, environment.

    The Contracting Specialist is responsible for analyzing contracts between Peak Health and its network providers for the various Peak Health products. Analyze data from various sources and systems for both physician and hospital services in order to present reports to key management and staff and to recommend and implement solutions to assist in the contracting decision-making process.

    MINIMUM QUALIFICATIONS:

    EDUCATION, CERTIFICATION, AND/OR LICENSURE:

    1. Bachelor's degree in Business Administration, Health Care Management OR High School Diploma and equivalent work experience.

    EXPERIENCE:

    1. One (1) year of work experience in healthcare data analytics, healthcare consulting analytics or healthcare contracting analytics.

    2. One (1) year of related healthcare insurance experience in related contractual, financial or provider related activities with major healthcare insurance companies.

    PREFERREDQUALIFICATIONS:

    EDUCATION, CERTIFICATION, AND/OR LICENSURE:

    1. Direct experience in data analysis, financial analysis and reporting to include proficient extracting information from various payer systems; utilizing information obtained in most applicable manner; and developing complex mathematical models

    2. Progressive experience in health care management, physician groups, hospitals, payer contract negotiations, legal reviews of contract, or contact management preferred.

    3. Consulting and/or healthcare decision support work experience in the healthcare industry preferred.

    CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

    1. Conducts negotiations with hospitals, physicians and ancillary providers on behalf of Peak Health.

    2. Presents healthcare data in a meaningful, concise and beneficial manner to upper management.

    3. Utilizes data to provide consulting service and decision support on healthcare topics critical to health plan system wide decisions for upper management.

    4. Develops and maintains tracking system for reimbursement and statistical information. Ensures data integrity and accuracy.

    5. Summarizes offers for review with appropriate Peak Health committees and individuals.

    6. Communicates the implementation of new and renewal contracts to upper management and monitors the reimbursement to ensure accurate payment of claims by Peak Health.

    7. Audits large volumes of data and conducts in-depth quantitative analysis of results and evaluates trends.

    8. Communicates and educates other regarding financial improvement analysis, findings and recommendations.

    9. Maintains contract files for Peak Health.

    10. Maintains physician fee and hospital rate information for Peak Health contracted providers.

    11. Maintains contract information on major providers with selected competitor and benchmark providers.

    12. Organizes meeting materials and attends various organization meetings as needed as well as assists in development of annual strategic planning.

    13. Works with providers to resolve provider billing, denial, and appeal issues and explores hassle reduction improvements to incorporate into new and existing contracts.

    14. Must remain current with how information is collected, maintained and reported in all key systems.

    15. Participates in meeting the objectives of the work unit and goal of the department.

    PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    1. Standard office environment.

    SKILLS AND ABILITIES:

    1. Thorough understanding of healthcare regulations.

    2. Ability to perform contract modeling.

    3. Understanding of healthcare reimbursement payment methodologies.

    4. Strong problem solving and quantitative abilities.

    5. Excellent communication and collaboration skills.

    6.Attention to detail.

    Additional Job Description:

    insurance/health plan

    remote

    Scheduled Weekly Hours:

    40

    Shift:

    Exempt/Non-Exempt:

    United States of America (Exempt)

    Company:

    PHH Peak Health Holdings

    Cost Center:

    2901 PHH Provider Management
    Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

    The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

     

  • 18 Days Ago

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TELECOMMUNICATIONS NETWORK SPECIALIST III
  • West Virginia Network for Educational Telecomputing (WVNET)
  • Morgantown, WV FULL_TIME
  • TELECOMMUNICATIONS NETWORK SPECIALIST III WVNET is seeking to hire a new Telecommunications Network Specialist III to analyze, design, configure, install, deploy and troubleshoot LAN, WAN, Campus netw...
  • 2 Months Ago

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Advanced Practice Provider – Nurse Practitioner / Physician Assistant
  • Transformations Care Network
  • Morgantown, WV FULL_TIME
  • Transformations Care Network is an established network of behavioral health clinics that, out of a passion for providing superior patient care, is empowering our clinicians and customer service teams ...
  • 1 Day Ago

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Resident Support Specialist
  • Sojourners Care Network
  • Athens, OH PART_TIME
  • Job Announcement Sojourners Care Network Resident Support Specialist Sojourners Care Network is a non-profit organization that provides shelter and support services to young people who are experiencin...
  • 10 Days Ago

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(Hybrid) Parent Network Specialist - Center for Excellence in Disabilities in Co
  • West Virginia University Research Corporation
  • Morgantown, WV FULL_TIME
  • Description West Virginia University Research Corporation is seeking applications for a hybrid Parent Network Specialist for the Center for Excellence in Disabilities in Counties Wood, Logan and Monon...
  • 1 Month Ago

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Hearing Instrument Specialist/ Audiologist (2nd Provider) Granville, WV
  • Hearing Lab Technology, LLC
  • Granville, WV FULL_TIME
  • Job DescriptionHearing Instrument Specialist / Audiologist Sam’s Club Granville, WV, USAFull-time: Tuesday-Saturday Position: Specialist (HIS or AuD) Job DescriptionOur Mission: "Helping People Hear B...
  • 1 Day Ago

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0 Provider Network Specialist jobs found in Morgantown, WV area

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Mid-Level Systems Engineer
  • Fusion Technology LLC
  • Fairmont, WV
  • Who is Fusion Technology? Fusion Technology is a performance-driven HUBZone Small Business concern residing in the heart...
  • 3/28/2024 12:00:00 AM

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Devops Engineer
  • Syms Strategic Group, LLC (SSG)
  • Morgantown, WV
  • Syms Strategic Group (SSG) is seeking a talented DevOps Engineer Please join SSG on this large, highly complex nationwid...
  • 3/28/2024 12:00:00 AM

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Intrusion Analyst
  • Leidos
  • Fairmont, WV
  • Description Looking for an opportunity to make an impact? Join the Leidos Civil IT (CivIT) team in accelerating cybersec...
  • 3/27/2024 12:00:00 AM

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Red Hat Engineer
  • Leidos
  • Fairmont, WV
  • Description Looking for an opportunity to make an impact? Join the Leidos Civil IT (CivIT) team in accelerating cybersec...
  • 3/26/2024 12:00:00 AM

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Windows Administrator Lead
  • Leidos
  • Fairmont, WV
  • Description Leidos is a Fortune 500™ company aimed at embracing and solving some of the world’s most pressing challenges...
  • 3/25/2024 12:00:00 AM

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IT Network Operations Manager
  • ManTech International Corporation
  • Fairmont, WV
  • Secure our Nation, Ignite your Future Become an integral part of a diverse team while working at an Industry Leading Org...
  • 3/25/2024 12:00:00 AM

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Information Professional
  • US Navy
  • Morgantown, WV
  • About In the Navy, information technology (IT) plays an important role in everything from electronic mail systems, to sh...
  • 3/24/2024 12:00:00 AM

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Software Engineer
  • Leidos
  • Morgantown, WV
  • Description Come take your career to the next level! The Command and Control Incident Management Emergency Response Appl...
  • 3/21/2024 12:00:00 AM

Morgantown is a city in and the county seat of Monongalia County, West Virginia, United States, situated along the banks of the Monongahela River. It is known as the home of West Virginia University and the Morgantown Personal Rapid Transit (PRT) system. With a permanent population of 31,073 per the 2015 U.S. Census estimates, Morgantown is the largest city in North-Central West Virginia. The Morgantown metropolitan area has a population of 138,176. Morgantown is located 75 miles (121 km) south of Pittsburgh, Pennsylvania, 208 mi (335 km) north-northwest of Washington, D.C., 81 mi (130 km) eas...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$57,583 to $86,114
Morgantown, West Virginia area prices
were up 1.2% from a year ago

Provider Network Specialist in Springfield, MO
As the liaison between provider and the health plan, candidates are tasked with ensuring improved revenue generated and patient quality score.
December 16, 2019
Provider Network Specialist in Stamford, CT
Previous experience in a network development, provider recruitment or provider contracting.
December 04, 2019
Provider Network Specialist in Fort Wayne, IN
In this position, employees will be expected to perform benefits analysis and create reports on provider performance to support the needs of the analysis found.
January 18, 2020