Provider Relations Network Specialist Jobs in Iowa

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

Extremely strong interpersonal, written, and verbal communication skills.

Experience writing documentation or producing other content to synthesize and simplify technical concepts for technical and non-technical audiences

Experience with developer relations and developer support

Experience teaching, writing, or hosting workshops

Experience working with distributed systems (cyber security, cloud computing, networks, etc.)

Experience working in or managing open source software communities

Assist in continual training to assigned providers on best practices and other resources to assist with claims, authorizations, member benefits, etc.

Strong communication skills and ability to use appropriate tact and finesse when dealing with delicate issues

Strong organizational skills to coordinate new partnerships and keep processes moving

Ability to think outside the box and offer new suggestions for integrating new procedures

Experience working in a healthcare, provider or HMO/PPO environment familiar with billing claims and authorization processes

Position Responsibilities may include, but not limited to

Bachelor's degree in a related field, or at least 4 additional years of experience in healthcare, network development, network management.

5-8 years experience in a Provider Relations role for a managed care plan.

Takes the front-line in establishing and maintaining strong communications with providers. Collaborates with Regional Managers and manages staff and support activities.

Solid knowledge of health plan operations required.

Assists with network strategy committee meeting and network application processing decision committees

Collaborates and monitors with credentialing teams to ensure provider compliance with provider and state contracts.

High school diploma, GED, or equivalent work experience

Initiates phone calls to customers, (providers/pharmacies/patients/carriers etc.) to confirm receipt of mailings, and to request action.

Provides timely response and resolution for all provider initiated inquires (phone calls, emails or faxes).

Reviews and analyzes documentation and claim data to determine validity and proper action.

Updates accounts receivable system with denial and group information.

Assists with high priority special projects

Experience using Contract Management software including maintaining and managing databases

Draft and manage communication efforts on behalf of Network Management, Client Engagement, Compliance, and Government Programs to participating pharmacies

Bachelor’s degree in Business or related area of study, or equivalent combination of education and/or relevant work experience

Pharmacy Technician certification (CPhT) or equivalent pharmacy experience

Enhanced organizational skills with the ability to work on multiple projects simultaneously

Expert verbal and written presentation skills