Provider Network Specialist

We are currently looking for a Customer Service Healthcare professional that has worked with providers and worked in Claims billing/coding. This position will be a 6-month contract for one of our Tampa clients. The person in this position will act as a liaison between providers, the health plan and Corporate as well as assisting with Claim resolution.

Pay: $16-17hr

Job Responsibilities:

  • 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. 

Requirements:

  • 2-4 years of Healthcare experience in an office setting
  • Bachelor’s degree in related field or equivalent experience
  • Knowledge of health care, managed care, Medicare or Medicaid
  • Claims billing/coding knowledge

Rec123

Category:Customer Service
City/State/Zip:Tampa, Florida 33634
Job ID:12313
 

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