Overview
On Site
Depends on Experience
Contract - W2
Job Details
Provider Network Representative | 4 Years of Experience | Hybrid | Albuquerque, NM | Contract
Walker Healthforce is seeking a Provider Network Representative with 4Years of Experience to support a healthcare payor client based out of Albuquerque, NM. This is a 6 month contract opportunity.
START DATE: ASAP
HOURS/SCHEDULE: M-F; 8AM-5PM
WORKER TYPE: W2
CORE REQUIREMENTS:
Walker Healthforce is seeking a Provider Network Representative with 4Years of Experience to support a healthcare payor client based out of Albuquerque, NM. This is a 6 month contract opportunity.
START DATE: ASAP
HOURS/SCHEDULE: M-F; 8AM-5PM
WORKER TYPE: W2
CORE REQUIREMENTS:
- Bachelor’s degree
- OR 4 years of work experience in the health care/insurance industry.
- 3 years of 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 of experience using a PC.
- Familiarity with provider reimbursement methods.
- Strong analytical and organizational skills.JOB RESPONSIBILITIES:
- Provide information and assistance needed to resolve problems experienced by practitioners in their various contractual relationships with HCSC, including but not limited to claims, pricing, or contracts. Ensure both parties understand the mechanics of the provider relationship and that networks are functioning effectively. Record activities per regional and management requirements. Keep management informed of activities and needs.
- Assist in training and ongoing policy education for provider staff and others as needed. Conduct provider servicing and help develop and distribute training materials.
- Submit reports on service and recruiting activities and other items as required by management.
- Respond to fee requests from providers.
- Support ongoing development of databases, reports, and statistical analyses of managed care networks. Create, modify, and maintain reports to provide accurate internal and external information.
- Assist in coordinating and resolving systemic problems and claims issues. Identify problems, research causes and impact, and coordinate resolutions with internal staff or providers.
- Assist with the review and maintenance of provider directories for managed care networks.
- Develop and maintain effective working relationships with Core Services, Local Medical Directors, and other internal departments. Coordinate recruitment, servicing, and retention of contracted providers.
- Establish and maintain relationships with key facilities, physician groups, practice managers, IPAs, PHOs, and other essential contacts. Act as liaison between facilities or provider offices and internal departments.
- Maintain a high level of expertise in pricing arrangements, contract requirements and language, benefits, membership, claims processing, utilization review, etc.
- Process provider change forms, maintain tickler system, and verify that all changes are correctly updated in the appropriate systems.
- Prepare monthly reports and update provider databases as necessary. Assist with both routine and special reporting requirements.
- Prepare and mail provider orientation packets, manuals, and application packets.
- Communicate and interact effectively and professionally with co-workers, management, and customers.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable corporate and departmental policies.
- Maintain complete confidentiality of company business.
- Keep management informed of developments in assigned responsibilities and perform special projects as requested.
- Competitive compensation package
- Weekly pay via Direct Deposit
- Medical, Dental & Vision available
- 401k options
WHY WORK WITH WALKER- Access to our top ranked team of recruiting and placement specialists
- Continuous, one-on-one support from a dedicated engagement manager
- Professional resume development and interview preparation
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US:
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
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