Pay rate is ***- ***/hour
Expectation to work a hybrid schedule - 3 days onsite, 2 WFH. To work hybrid, candidate must have their own equipment or supplier-issued equipment for WFH. Otherwise, position is onsite.
This is a training position where the incumbent will learn to perform the following functions competently:
Provide information and assistance to resolve problems experienced by practitioners in their contractual relationships with HCSC, including claims, pricing, or contracts. Ensure both parties understand the mechanics of our relationship and that networks are functioning well. Record activities as required and keep management informed.Assist in training and ongoing policy education on all aspects of HCSC operations to provider staff and others. Conduct provider servicing and help develop and distribute training materials.Submit reports on service, recruiting activities, and other items as required.Respond to fee requests from providers.Develop and maintain database, reports, and statistical analyses of managed care networks. Create and update reports for internal and external use.Assist with resolving systemic problems and claim issues by identifying, researching, and reporting problems, coordinating resolutions with internal staff or providers.Review provider directories for managed care networks.Build and maintain relationships with Core Services, Local Medical Directors, and other departments. Coordinate for provider recruitment, servicing, and retention.Establish relationships with facilities, physician groups, practice managers, IPAs, PHOs, and other contacts. Serve as liaison between provider offices and internal departments.Maintain expertise in pricing, contracts, benefits, membership, claims processing, and utilization review.Process provider change forms, ensure updates are made in systems, and maintain tickler systems.Prepare monthly reports, update provider databases, and assist with reporting requirements.Prepare and mail provider orientation packets, manuals, and applications.Communicate professionally with co-workers, management, and customers.Comply with HIPAA, Diversity Principles, Corporate Integrity, and other policies.Maintain confidentiality of company business.Communicate with management about developments and perform special projects as needed.JOB REQUIREMENTS:
- Bachelor's Degree OR 4 years of work experience in healthcare/insurance.
- 3 years experience in Network Management, Credentialing, or Customer Service, with understanding of healthcare contracts, applications, and products.
- Working knowledge of claims processing systems.
- 3 years experience using a PC.
- Strong verbal and written communication skills.
- Teamwork and problem solving skills.
- Analytical and organizational skills, with ability to meet deadlines under pressure.
- Familiarity with provider reimbursement methods.
PREFERRED JOB REQUIREMENTS:
- Knowledge of healthcare policies, products, and procedures.
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate based on Minority, Gender, Disability, Religion, LGBTQI, Age, or Veterans status.
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