Network Specialist

4 days ago

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Devoted Health

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health care • data science • technology • medicare advantage • design

1001 - 5000

Description

•This role will be instrumental in analyzing provider demographic information, financial data, quality reports, and special project data. •The ideal candidate will assist the network team in preparing for monthly IPA meetings. •Have knowledge of provider contracts, claims payments, provider set up, and root cause analysis. •Exhibit a proven ability to work independently, while still working with a team, exhibit strong organizational skills and is goal oriented. •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 network team. •Analysis of network grievances, determination of track and trend or provider outreach, complete outreach as needed, prepare monthly reporting. •Contracting to support network adequacy in existing and expansion counties. •Contract processing, to include: obtaining contract signatures, preparing provider rosters, submitting contract load form. •Assist with Field Network cases, outreach to providers, documentation of resolution. •Evaluate participation requests against network need, current contractual relationships, expansion efforts, access to care. •Make recommendations to management. Contract as needed. •Respond accordingly to providers. •Assist network managers with monthly JOC meeting preparations, research outliers in financial reports, audit reports for accuracy, assist with follow up items from meetings.

Requirements

•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. •Experience in claims research, provider set up, root cause analysis, process improvement.

Benefits

•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 •Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles •Parental leave program •401K program •And more....