Provider Network Specialist (Provider Relations) - Saco, ME

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

Qualifications

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.

Additional Information

All your information will be kept confidential according to EEO guidelines.