What are the responsibilities and job description for the Healthcare Provider Servicing Specialist position at Provider Network Solutions?
* On the road - Not remote position - Authorization to work in the US required *
Position Summary
Manages all Specialty Physician networks by developing and maintaining relationships to drive business results within a specific geographic area. Provides service and education to Network groups and staff. Achieves company targets through implementation of the policies and procedures.
Duties and Responsibilities
- * Completes new group orientations within thirty (30) days of health plan effective date for all applicable health plan partners’ product lines.
- * Conducts quarterly site visits to resolve issues, educate new staff/groups on policies, collect new/updated credentialing information, and review any changes/updates to the Network Manual or Network guidelines.
- * During initial onboarding, meets with the appropriate Network Group personnel and fully explains the company’s protocols, including but not limited to, all requirements necessary to comply with standards identified in the Network Manual.
- * Achieves quarterly servicing goals to establish consistent and strong relationships with Network Group offices; including but not limited to Network Providers rosters, Heatlh Plan requirements/updates, Bi-Monthly checks (if applicable), Provider Manual Ack Form and Office Visit Ack form.
- * Provides oversight and education to Network Groups on inquiries and claims issues and follows-up with Network Group and Provider Servicing Coordinator to ensure issues have been resolved.
- * As applicable, will forward identified network gaps to the VP of Network Management to fill the deficiencies.
- * Liaison, in conjunction with Provider Servicing Coordinator, to all health plans.
- * Understands and explains network group contracts, if needed.
- * Strategizes for network groups and health plan retention.
- * Special projects as assigned or directed.
- * Exercises discretion and independent judgment in matters involving the servicing of providers.
Knowledge
- * A Bachelor’s Degree in a related field or equivalent related Network Development or Provider Relations experience.
- * Minimum three (3) years’ experience in Medicaid/Medicare is preferred.
- * Healthcare, provider office or HMO/PPO background preferred.
- * Strong knowledge of regulatory requirements concerning Medicare and Medicaid preferred.
Skills
- * Excellent problem-solving skills.
- * Proficient oral and written communication skills.
- * Bilingual language skills a plus.
- * Intermediate Microsoft Office skills.
- * Deductive Reasoning
- * Works well individually and/or with team setting
Job Type: Full-time
Pay: $50,000.00 - $55,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Language:
- English (Required)
Ability to Relocate:
- Jacksonville, FL (Duval County): Relocate before starting work (Required)
Willingness to travel:
- 100% (Required)
Work Location: On the road
Salary : $50,000 - $55,000
