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Provider Network Representative

Location: Richardson, TX, United States
Job Type: Full Time
Job Category: Call Center
Job Industry: Insurance
Salary: The pay we're offering is $30 per hour
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The Opportunity

Description

We're looking for a Provider Network Representative, working in Insurance industry in Richardson.

  • Provide information and assistance needed to resolve problems experienced by practitioners in their various contractual relationships with HCSC, including but are not limited to claims, pricing, or contracts. Assure both parties understand the “mechanics” of our relationship with these providers and that our various networks are working well for all involved. Record activities in the specific format required by the region and management. Keep management advised of activities and needs accordingly.
  • Assist in providing training and continuing policy education on all facets of operations of HCSC to provider staff and others as needed. Conduct provider servicing and assist in the development and distribution of appropriate training materials, etc., as needed.
  • Submit reports on service and recruiting activities and other items as required by management.
  • Respond to fee requests from providers.
  • Provide ongoing development of database, reports and statistical analyses of managed care networks. Create, modify and maintain new and existing reports to provide accurate information for both internal and external reporting.
  • Assist with the coordination and resolution of “systemic” problems and claim issues. Identify problem and research the impact and origin for resolution. Report problem to management and coordinate with either internal staff or the provider to assure resolution.
  • Assist with the review of provider directories for the managed care networks.
  • Develop and maintain a good working relationship with Core Services, Local Medical Directors, and other internal departments. Coordinate with various HCSC departments as required for the recruitment, servicing and retention of contracted providers.
  • Establish working relationship with key facilities, physician groups, practice managers, IPAs, PHOs and other essential contacts. Serve as liaison between facilities or provider office staff and various internal departments.
  • Maintain a high level of expertise in pricing arrangements, contract requirements/language, benefits, membership, claims processing, utilization review, etc.
  • Process provider change forms. Maintain tickler system and verify that all changes have been made in the appropriate system.
  • Prepare monthly reports and update provider databases as necessary. Assist with routine and special reporting requirements.
  • Prepare and mail provider orientation packets, provider manuals and application packets.
  • Communicate and interact effectively and professionally with co-workers, management, customers, etc.
  • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
  • Maintain complete confidentiality of company business.
  • Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Our Client

Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20+ years’ experience and growth.

Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.

Big enough to have great opportunities. Small enough to care about finding the right one for you.

It’sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?

Experience Required for Your Success

  • Bachelor Degree OR 4 years work experience in the health care/insurance industry.
  • 3 years experience in Network Management, Credentialing and/or Customer Service.
  • Understanding of health care contracts, applications and products.
  • Working knowledge of claims processing systems. 3 years experience utilizing a PC.
  • Verbal and written communication skills.
  • Teamwork and problem solving skills. Analytical and organizational skills.
  • Organizational skills and experience meeting deadlines and working well under pressure.
  • Familiar with provider reimbursement methods.
  • Network Management Experience/Provider Contracting

Preferred:

  • Knowledge of health care policies, products and procedures.

What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible? Apply Now

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