Devoted Health

Our mission: to dramatically improve the health & well-being of older Americans by caring for everyone like family

Provider Network Specialist

Full TimeRemoteTeam 1,001-5,000Since 2017H1B No SponsorCompany SiteLinkedIn

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....

Related Categories

Related Job Pages