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Provider Network Specialist I
Ref No.: 18-17791
Location: Tacoma, Washington
Position Type:Direct Placement
Start Date: 03/16/2018
Job Title: Provider Network Specialist I
Location: Tacoma, Washington
Duration: Full Time

Notes: Need experience in healthcare industry and also bachelor's degree in healthcare.

Job description:
  • Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate. Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.
  • Serve as primary contact for providers and act as a liaison between the providers and the health plan
  • Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution
  • Receive and effectively respond to external provider related issues
  • Provide education on health plan's innovative contracting strategies
  • Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network
  • Investigate, resolve and communicate provider claim issues and changes
  • Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
  • Perform provider orientations and ongoing provider education, including writing and updating orientation materials
  • Ability to travel
  • Education/Experience: Bachelor's degree in related field or equivalent experience.
  • 0-2 years of provider relations or contracting experience.
  • Knowledge of health care, managed care, Medicare or Medicaid.
  • Bachelor's degree in healthcare or a related field preferred.
  • Claims billing/coding knowledge preferred.
  • Licenses/Certifications: Current state driver's license. For South Carolina only - Current state driver's license preferred.