Network Management Rep
Core
Resolves complex provider issues, appeals, billing disputes, and claims to ensure providers are paid according to contracted terms.
Role type
Provider relationship account manager
Builds
Claims resolution and provider satisfaction
Domain
Healthcare administration
Deliverable
client delivery
Required skills
problem-solving, analytical skills, policy interpretation
Preferred skills
facilitation, oral and written communication
Responsibilities
Researches and resolves complex provider issues and appeals; Coordinates claims resolution; Performs provider on-site visits; Analyzes provider utilization patterns; Determines payment compliance with contracts.
Seniority
Individual contributor, 3+ years experience
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