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Provider Network Representative Jobs

Analyst, Network & Provider Analytics
By Point32Health At , Remote
Under direct supervision, conduct detailed analyses that offer the Provider Performance Management team insights into cost drivers and best practices
Bachelors in Business Administration, Finance, Health Services required; Masters preferred
Strong oral, written and presentation skills
Key Responsibilities/Duties – what you will be doing
Qualifications – what you need to perform the job
Work under direct supervision to generate and enhance standard cost and utilization reports
Analyst, Provider Configuration - Network Adequacy/Sql - Remote
By Molina Healthcare At , Long Beach, 90802 $54,922 - $107,099 a year

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Provider Data Specialist_ Provider Network
By Versant Health At , Remote $18.50 - $20.00 an hour
One to three (3) years of data entry experience
Peer review of database revisions to meet Quality Check requirements
One to three (3) years of experience working with claims and/or provider demographic information
Experience working with provider networks and healthcare providers
Ability to use MS Excel and Access to manage work items and manipulate data, preferred
Previous experience in running a wide variety of Geo Access and/or Quest Analytics reports is preferred
Director Of Provider Network - Remote | Wfh
By Get It Recruit - Healthcare At New York, NY, United States

Are you ready to make a significant impact in the healthcare industry? Join a dynamic team that is dedicated to improving patient outcomes and revolutionizing care delivery. We are seeking an ...

Provider Service Representative Jobs
By Alignment Health At California, United States
Minimum 5+ years’ experience in provider relations, managed care or a physician’s office.
Supports department efforts and Provider Relations Manager by participating in interdepartmental meetings and selected committees.
Strong analytic, quantitative, and problem-solving skills required.
Strong verbal and written communication skills required.
Strong presentation skills and ability to appropriately and effectively address diverse audiences required.
General Duties/Responsibilities (May Include But Are Not Limited To)
Provider Network Specialist Jobs
By Premera Blue Cross At United States
Provide input on improvements regarding workflow, procedures, or policies and make recommendations to management.
Assure compliance with the National Committee for Quality Assurance (NCQA), Office of the Insurance Commissioner (OIC) and other regulatory agencies/requirements.
Three (3) years' experience in a production or customer service environment requiring attention to detailed procedures (Required).
One year of prior health care and provider information experience; medical office or billing experience.
Knowledge of other internal department operations or functions that assist in resolution of provider inquiries.
Experience in working with Microsoft Word and Excel.
Director Of Provider Network Development
By JLC Recruiting New York At United States
Thorough knowledge of laws and regulations relating to managed care and other payer functions.
This role is remote based (work from home) and will require approximately 35% travel throughout NY State
Administration (MHA); or equivalent education/experience such as bachelor’s degree in
a minimum of 10 years in leadership position-management of field-based teams
In partnership with National and local leadership, develop contracting growth strategies across all lines of the managed care portfolio.
Develop market level contracting strategies and alignment with finance and other operational areas of the organization.
Assoc Specialist, Provider Network Admin - Remote
By Molina Healthcare INC At United States
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Min. 1 year managed care experience
2+ years managed care experience
Associate's Degree or equivalent combination of education and experience
Reviews/analyzes data by applying job knowledge to ensure appropriate information has been provided.
Experience in one of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
Provider Relations Representative Jobs
By Fallon Health At Worcester, MA, United States
Develop and maintain positive and productive rapport with Fallon Health providers through proactive relationship management and communications.
Escalate conflicts to Manager of Provider Relations and when appropriate Director, Provider Relations.
Co-lead internal and external Joint Operations Committee meetings with contract managers.
Proficiency with desktop computer applications, Microsoft Office package and Mainframe knowledge (i.e. QNXT, IDX etc.)
Clear and concise written and verbal communication skills
Serve as primary Fallon Health contact for providers to resolve issues relating to the administration and operation of providers' contracted services.
Provider Network Manager Jobs
By Elevance Health At United States
Contracts frequently involve non-standard arrangements that require a moderate level of negotiation skills.
Job Family: Digital and Technology
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Primary focus of this role is contracting and negotiating contract terms for value-based agreements.
Typically works with providers engaged in value-based arrangements and non-traditional provider types supporting SDOH initiatives and whole-health care delivery.
Deep understanding of Value based concepts understanding and innovative thoughts on health equity and whole-health.
Provider Network Executive Iii
By Premera Blue Cross At United States
Develop and execute ongoing account management and service strategy to meet corporate strategic/financial objectives.
Bachelor’s Degree or (4) years of experience in a provider or payer environment. (Required)
Knowledge of network development and provider/vendor network recruitment.
Knowledge of provider community and market anomalies.
Demonstrated ability to effectively manage complex contract negotiations.
Strong experience and expertise in Provider Relations.
Provider Network Account Specialist
By HonorHealth At Scottsdale, AZ, United States

network development or physician recruiting/sales

This is a Full-time position, but requires you to travel locally to meet with potential clients.

Medicare Network Account Provider Performance Analyst - Cigna Healthcare -Remote, Or
By Cigna Healthcare At Portland, OR, United States
Supporting the development, management and oversight of the physician/ provider network in his/her assigned territories
Developing time and cost effective territory management in compliance with department and enterprise goals.
Educating providers on the performance requirements associated with value-based contracts.
Direct experience with health plan operations, preferably specific to government sponsored health plans
Schedules, prepares for and participates in meetings with providers, provider staff, and/or physician leadership including creating and delivering presentations. 
Assisting in initiatives and performing special projects and other duties as assigned by leadership
Director, Network Management (Provider Relations) (Director Ii)
By CalOptima At Orange, CA, United States
Bachelor’s degree in Health Care Management or a related field required.
5 years of progressive leadership experience, including direct supervision of staff, in managed care, providers or health plans required.
Medicaid managed care, Medicare risk-contract, or commercial Health Maintenance Organization (HMO) insurance experience required.
Master’s degree in Health Care Management or related field.
Medi-Cal managed care plan experience or related government client or public sector experience.
Directs training of providers to promote cost-effective managed care, compliance, and enhancement of service standards.
National Provider Network Coordinator
By iCare Health Solutions At United States

Description The National Provider Network Coordinator will work closely with the Provider Recruiting and Contracting team(s) to organize recruitment efforts, providing analytical and administrative ...

Provider Network Reporting Analyst
By Medical Mutual of Ohio At ,
1-year experience in health insurance provider operations/data management which includes exposure to network reporting or similar analytics.
2 years’ experience as a Provider Network Reporting Analyst or equivalent experience in health insurance provider operations/data management.
5 years progressive experience as a Provider Network Reporting Analyst or equivalent experience in health insurance provider operations/data management.
Bachelor’s degree in Business Administration, Statistics or related field or equivalent combination of training/education and experience.
Acts as a resource for colleagues with less experience
Knowledge of provider data structure, including tax ID, demographics, etc.
Lead Director, Network Provider Relations (Medicaid) (Remote Il Based)
By CVS Health At , , Il $100,000 - $227,000 a year
Assist and develop Network Action Plans to ensure Network Compliance with any and/all State Network Compliance requirements
Manages Local Provider Engagement Team to Deploy National Engagement Model
Manages Local Provider Relations staff to ensure Market Leading Provider Satisfaction
Oversees the monitoring of executed provider contracts to ensure Network Access meets State requirements.
Excellent interpersonal skills and the ability to work with others at all levels
Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
Network Manager Provider Partnerships
By Blue Cross Blue Shield of Massachusetts At , Hingham, 02043, Ma $90,090 - $110,110 a year

***This position is eligible in the following personas:

Provider Network Helpdesk Specialist (Full-Time Remote, North Carolina Based)
By Alliance Health At , Morrisville, 27560, Nc $17.32 - $29.82 an hour
Knowledge of and experience with records, reports and file maintenance
Paid time off including vacation, sick leave, holiday, management leave
Respond to question regarding claims and UM requirements
Knowledge of computerized record-keeping techniques
Skilled at organizing work to meet schedules and timelines
Flexible work schedules including hybrid/remote options
Provider Network Data Analyst I
By AmeriHealth Caritas At , Raleigh, Nc
Management requirements are adhered to including language, terms and reimbursement requirements
Demonstrates a functional knowledge of provider data and managed care provider reimbursement methodologies.
Knowledge of Managed Care concepts
Responsible for the accuracy and timely management of the provider contracts
Bachelor’s Degree or equivalent education with work experience required.
Responsible for data intake process including knowledge of relevant systems required to complete job functions.

Are you looking for a job that allows you to help people while using your customer service skills? We are looking for a Provider Network Representative to join our team! You will be responsible for helping customers navigate our provider network and ensuring they receive the best care possible. If you are a people-person with excellent communication skills, this could be the perfect job for you!

A Provider Network Representative is responsible for managing and maintaining relationships with healthcare providers and other stakeholders in the healthcare industry. They are responsible for ensuring that providers are in compliance with all applicable laws and regulations, and that they are providing quality care to their patients.

What is Provider Network Representative Skills Required?

• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Ability to manage multiple tasks and prioritize workload
• Knowledge of healthcare industry regulations and standards
• Knowledge of healthcare reimbursement and claims processing
• Knowledge of provider network management
• Knowledge of provider contracting and credentialing
• Knowledge of provider network software systems

What is Provider Network Representative Qualifications?

• Bachelor’s degree in healthcare administration, business administration, or related field
• At least two years of experience in provider network management
• Knowledge of healthcare industry regulations and standards
• Knowledge of healthcare reimbursement and claims processing
• Knowledge of provider network management
• Knowledge of provider contracting and credentialing
• Knowledge of provider network software systems

What is Provider Network Representative Knowledge?

• Knowledge of healthcare industry regulations and standards
• Knowledge of healthcare reimbursement and claims processing
• Knowledge of provider network management
• Knowledge of provider contracting and credentialing
• Knowledge of provider network software systems

What is Provider Network Representative Experience?