Senior Provider Engagement Network Specialist
Core
Manage provider network relationships, ensure accurate provider data in state systems, and resolve complex contract and claims issues for a health plan.
Role type
Senior Provider Engagement Network Specialist
Builds
Provider directories, network reporting, and claims payment resolutions
Domain
Healthcare / Managed Care
Deliverable
dashboards & analysis
Required skills
Provider contracting, benefits interpretation, contract rate analysis, appeals and grievances resolution, database administration, stakeholder liaison
Preferred skills
Managed health care environment experience, provider services experience
Technologies
Provider information systems, state reporting systems
Responsibilities
Maintain provider databases and directories, act as liaison for assigned physician groups, resolve complex contract and claims issues, provide training and education to providers, serve as subject matter expert for provider contracts
Seniority
Senior, hands-on IC