Provider Network Representative

3 days ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. Innovative Systems Group provided pay range This range is provided by Innovative Systems Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $24.00/hr - $24.00/hr Direct message the job poster from Innovative Systems Group Job Title: Provider Network Representative Location: Alb NM | Hybrid, 3 days onsite 2 WFH Pay rate: $24.00/hr on W2 Description:

1. Provide information and assistance needed to resolve problems experienced by practitioners in their various contractual relationships with HCSC, including but are not limited to claims, pricing, or contracts. Assure both parties understand the mechanics of our relationship with these providers and that our various networks are working well for all involved. Record activities in the specific format required by the region and management. Keep management advised of activities and needs accordingly.
2. Assist in providing training and continuing policy education on all facets of operations of HCSC to provider staff and others as needed. Conduct provider servicing and assist in the development and distribution of appropriate training materials, etc., as needed.
3. Submit reports on service and recruiting activities and other items as required by management.
4. Respond to fee requests from providers.
5. Provide ongoing development of database, reports and statistical analyses of managed care networks. Create, modify and maintain new and existing reports to provide accurate information for both internal and external reporting.
6. Assist with the coordination and resolution of systemic problems and claim issues. Identify problem and research the impact and origin for resolution. Report problem to management and coordinate with either internal staff or the provider to assure resolution.
7. Assist with the review of provider directories for the managed care networks.
8. Develop and maintain a good working relationship with Core Services, Local Medical Directors, and other internal departments. Coordinate with various HCSC departments as required for the recruitment, servicing and retention of contracted providers.
9. Establish working relationship with key facilities, physician groups, practice managers, IPAs, PHOs and other essential contacts. Serve as liaison between facilities or provider office staff and various internal departments.

JOB REQUIREMENTS:

• Bachelor Degree OR 4 years work experience in the health care/insurance industry
• 3 years experience in Network Management, Credentialing and/or Customer Service.
• Understanding of health care contracts, applications and products.
• Working knowledge of claims processing systems.
• 3 years experience utilizing a PC.
• Familiar with provider reimbursement methods.

PREFERRED JOB REQUIREMENTS:

• Knowledge of health care policies, products and procedures.
• Excel saavy, customer service skills, MCO experience

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