Provider Network Specialist Jobs

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Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.

Forbes ranked Premera among America’s 2023 Best Midsize Employers because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

The Provider Network Specialist is responsible for maintenance of all professional and institutional providers, including national network provider information within the provider source systems and other applicable systems. The will research and update provider demographic information timely and accurately for directories, provider mailings and claims payment. The Provider Network Specialist will act as a liaison between Premera Blue Cross and its providers.

What you will do:

• Maintain accurate and complete electronic documentation on all provider correspondence.
• Complete special projects and other duties as assigned.
• Research and resolve provider inquiries and complex claims issues relating to provider information by investigation/review within department standards/processes.
• Assist Customer Service with inquiries and unique provider issues.
• Verify provider information for In Network and Out of Network providers (including but not limited to demographic information, remittance, location address, licensure etc., utilizing applicable resources (ex. Phone, email, vendor databases etc.).
• Process incoming provider information updates and contract implementation requests, utilizing different applications and websites (ex. Vendor databases, licensing website) and complete the necessary updates into the provider source system.
• Provide input on improvements regarding workflow, procedures, or policies and make recommendations to management.
• Ensure data integrity of provider directories for all markets including all demographic, specialty, credentialing and both contractual and non-network participation.
• Coordinate with internal departments, such as Care Management, Claims, Customer Service, and Systems and Reporting to answer questions and resolve provider related problems
• Provide support for Provider Network Executives (PNEs) and Provider Network.
• Assure compliance with the National Committee for Quality Assurance (NCQA), Office of the Insurance Commissioner (OIC) and other regulatory agencies/requirements.
• Provide timely, accurate, and concise responses to inquiries made by internal departments and providers related to networks, contract information, agreement ids, claims, payment methods, on-line directory, provider mailings, and national networks.

What you will bring:

• Associates Degree.
• Knowledge of other internal department operations or functions that assist in resolution of provider inquiries.
• High School Diploma or GED (Required).
• One year of prior health care and provider information experience; medical office or billing experience.
• Experience in working with Microsoft Word and Excel.
• Three (3) years' experience in a production or customer service environment requiring attention to detailed procedures (Required).

What We Offer

• Tuition assistance for undergraduate and graduate degrees
• Generous Paid Time Off to reenergize
• Free parking
• Medical, vision and dental coverage
• Wellness incentives, onsite services, a discount program and more
• Retirement programs (401K employer match and pension plan)
• Life and disability insurance

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

National Salary Range:

$41,600.00 - $62,400.00

National Plus Salary Range:

$47,000.00 - $70,500.00

• National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.