Devoted Health
Our mission: to dramatically improve the health & well-being of older Americans by caring for everyone like family
Provider Network Specialist
Location
Alabama
Posted
8 hours ago
Salary
$65K - $85K / year
3 yrs expEnglish
Job Description
• Primary responsibility of assigned provider group’s performance - quality, stars and financial performance.
• Assist network managers with monthly JOC meeting preparations, research outliers in financial reports, audit reports for accuracy, assist with follow up items from meetings.
• Auditing functions: provider set up in Orinoco (demographic and fee schedules), online search tool, print directory, Periscope reports, claims payment.
• Determine root cause of issues and recommend process improvements.
• Provide clear analysis and next steps for the network team.
• Analysis of network cases and grievances , determination of track and trend or provider outreach, complete outreach as needed, prepare monthly reporting.
• Support network adequacy in existing and expansion counties.
• Contract processing, to include: obtaining contract signatures, preparing provider rosters, submitting contract load form.
• Assistance with Field Network cases, outreach to providers, documentation of resolution.
• Evaluate participation requests against network need, performance metrics, current contractual relationships, expansion efforts, access to care.
• Make recommendations to management and the national contracting team.
• Contract as directed by local leadership.
• Respond accordingly to providers.
Job Requirements
- 3+ years of direct provider interaction
- 3+ years healthcare experience with Medicare Advantage or other relevant experience.
- Proven track record of detail oriented work
- Ability to navigate Google or MS Suite of products as well as AI
- Experience in claims research, provider set up, root cause analysis, process improvement.
Benefits
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....