Provider Network Representative - Hybrid

Title: Provider Network Representative - Hybrid

Mandatory skills:

Network Management, Credentialing, Customer Service,
health care, insurance, health care contracts, health care applications, health care products,
claims processing systems, provider reimbursement, provider database, provider manuals,
PC, database, statistical analysis, application packets,
managed care network, provider directories, training materials,
contractual, claims, pricing, claim issues, pricing arrangements, contract requirements,
HIPAA, Diversity Principles, Corporate Integrity, Compliance Program,
benefits, membership, claims processing, utilization review,
Analytical, Record, Develop, problem solving, organizational, communication, meeting

Description:

This is a training position where the incumbent is learning to perform the following functions in a competent manner.
1. Provide information and assistance needed to resolve problems experienced by practitioners in their various contractual relationships with client, 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.
2. Assist in providing training and continuing policy education on all facets of operations of the client to provider staff and others as needed. Conduct provider servicing and assist in the development and distribution of appropriate training materials, etc., as needed.
3. Submit reports on service and recruiting activities and other items as required by management.
4. Respond to fee requests from providers.
5. 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.
6. 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.
7. Assist with the review of provider directories for the managed care networks.
8. Develop and maintain a good working relationship with Core Services, Local Medical Directors, and other internal departments. Coordinate with various client departments as required for the recruitment, servicing and retention of contracted providers.
9. 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.
10. Maintain a high level of expertise in pricing arrangements, contract requirements/language, benefits, membership, claims processing, utilization review, etc.
11. Process provider change forms. Maintain tickler system and verify that all changes have been made in the appropriate system.
12. Prepare monthly reports and update provider databases as necessary. Assist with routine and special reporting requirements.
13. Prepare and mail provider orientation packets, provider manuals and application packets.
14. Communicate and interact effectively and professionally with co-workers, management, customers, etc.
15. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
16. Maintain complete confidentiality of company business.
17. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

JOB REQUIREMENTS:
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.

PREFERRED JOB REQUIREMENTS:
Knowledge of health care policies, products and procedures.

Notes:
Expectation to work a hybrid schedule- 3 days onsite, 2 WFH. To work hybrid, candidate must have their own equipment or supplier issued to WFH. Otherwise, position is onsite.

VIVA USA is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.

Contact Details :

VIVA USA INC.
3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008