Provider Network Specialist

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.

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

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

This role will be instrumental in analyzing provider performance (STARS, Medical Cost of Care, CAHPS), demographic information, financial data, quality reports, and special project data. The ideal candidate will assist the market network team in preparing for monthly provider meetings and Joint Operating Committee meetings.. The ideal candidate will also have knowledge of provider reporting, contract management, claims payments, provider set up, and root cause analysis. A key to success will be someone who has exhibited a proven ability to work independently, while still working with a team, exhibits strong organizational skills and is goal oriented.

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.