Provider Network Specialist jobs in Winston Salem, NC

Competitive Compensation & Benefits Package!  

Position eligible for – 

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs

See attachment for additional details. 

Location:   Remote/Hybrid option; Available for any of the Partners locations in NC

Projected Hiring Range:  Depending on Experience

Closing Date:  Open Until Filled

Primary Purpose of Position: This position assists in the maintenance, development and management of the provider network for consumers who have been identified as having mental health, substance abuse or intellectual development disability needs.

Role and Responsibilities:  

The Provider Network Maintenance Supervisor’s primary duties may be one or more of the following:

• Provides direct supervision to maintenance  staff including, recruiting, hiring, training and providing disciplinary action to individuals as needed; Performs day to day duties of assuring that providers (individual, group, ancillary, etc.) are set up accurately in the provider information system for state reporting, claims payment, and directories.
• Responsible for multiple state deliverables, network reporting and directories
• Provide support to the external provider representative to resolve provider data issues
• Research and effectively respond to provider related issues
• Oversees  request of providers to join he Partners Network according to parameters determined for qualifications and needs of the Network;
• Obtains and maintains time sensitive confidential provider information;
• Oversees the completion of routine and ongoing site/service additions requests to ensure that services are consistent with funding requirements, best practices, provider contracts and federal/state rules and regulations;
• Interprets audit results, identifies trends/patterns that impact service/system quality, and then implements interventions aimed at addressing these trends/patterns with the outcome of services delivery to consumers at the highest degree of quality;
• Serves as a resource to other departments within the LME/MCO on provider maintenance  related issues;
• Serves as a liaison with other departments within the LME/MCO and with various NC DHHS Departments, per rule requirements, to coordinate Specialist’s activities and findings;
• Participates in Provider Forums as requested and provides technical support and assistance to Provider Councils as needed;
• Participates in oversight and monitoring reviews of the MCO including but not limited to accreditation reviews, Tailored Plan and Medicaid Direct reviews as appropriate;
• Develops and maintains policies and procedures related to provider maintenance.

Knowledge, Skills and Abilities: 

• Considerable knowledge of the laws, regulations and policies that govern the program
• Exceptional interpersonal and communication skills
• Strong problem solving, negotiation, arbitration, and conflict resolution skills
• Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint
• Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements
• Ability to make prompt independent decisions based upon relevant facts
• Ability to establish rapport and maintain effective working relationships
• Ability to act with tact and diplomacy in all situations
• Ability to maintain strict confidentiality in all areas of work

Education/Experience Required: Bachelor’s Degree and three (3) years of credentialing, auditing or monitoring experience in MH/SU/IDD, including two (2) years Administrative Supervisory experience.  Must have ability to travel.

Education/Experience Preferred:  Master’s Degree with clinical licensure preferred.  Certified Provider Credentialing Specialist (CPCS) and/or Registered Healthcare Information Technician (RHIT) preferred.