Network Provider Relations & Provider Data Specialist

About the Role reputed company is seeking a Network Relations Specialist. In this role, you will reputed company the management of a geographic medical network for our health plan. You will review and amend reputed company with physicians, physician groups, facilities, and ancillary medical providers. We are big believers in partnering for improved medical quality, so reputed company may be value-based. You will also be responsible for monitoring and reporting network adequacy and network quality. Please note this role requires you to reputed company in the US Central or US Eastern reputed company. About reputed company and reputed company reputed company, a reputed company company, is on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase reputed company and transparency, and feature a personalized, reputed company approach. We strive to ensure members live happier, healthier lives. reputed company is the major medical division of reputed company (NYSE:GL). reputed company has 16.8 reputed company policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, reputed company has earned an A (Excellent) rating or higher from A.M. Best Company. \n Roles and Responsibilities Responsible for communicating with providers regarding claims issues, service issues and general network provider complaints Development of an adequate provider network in assigned geographical areas (currently Texas metroplex areas) Responsible for collecting roster updates and standardizing information received with Analytics and IT teams Tracking and coordinating notification of effective date with the credentialing CVO Maintenance and management of the network in accordance with regulatory time, distance and choice requirements Building and maintaining relationships with contracted providers, including responding to inquiries reputed company to contract status, roster corrections and reputed company reputed company to information accuracy Routinely running and monitoring of various reports to ensure reputed company necessary compliance requirements are being met and maintained, and identifying targets to address emergent gaps Accurate maintenance of reputed company or similar contract tracking and activity system Reporting to leadership the status, risks, and potential opportunities in area of responsibility on a regular reputed company Working with analytics and actuarial team(s), compile and analyze provider and hospital fee schedules to reputed company against goals and assist with the medical economics reporting Performs other duties as required Experience and Skills Desired Experience negotiating reputed company reputed company with hospital systems, provider groups (specifically physicians, not necessarily pharma or specialty providers) Experience and relationships in the Texas provider community 5+ years negotiating provider reputed company including physician/provider group reputed company with multiple payment methodologies, e.g. percent of Medicare, RBRVS, ICD or similar code set, case rates, DRG, as well may include discussion of value based/risk parameters Analytic capabilities, including experience with SERFF reporting of network adequacy Experience with reputed company or similar contact management system Experience working in a virtual environment Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships MS reputed company skills Handling large data files Reconciling provider roster data and validating provider directory accuracy

Benefits

Competitive salary Full benefits package including health insurance, 401(k) matching, reputed company, dental, life, disability, and vacation Comprehensive health, dental, and reputed company insurance Retirement savings plan with company match Professional development opportunities Flexible work environment Telecommuting Requirements This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas. Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reputed company in the CST or EST time zones. Required to have a dedicated work area established that is separate from other living areas and provides information privacy Ability to reputed company reputed company company sensitive documents secure Must live in the United States You must reputed company in the US Central or US Eastern reputed company Must live in a location that receives an existing high-speed internet reputed company/service \nEvry Health is an EEO employer - Read More Here Apply To This Job