Provider Network Specialist

April 7

🏈 Ohio – Remote

Although this job is listed in Ohio, this company may be open to hiring remote in other states.

⏰ Full Time

🟡 Mid-level

🟠 Senior

🛜 Network Engineer

🦅 H1B Visa Sponsor

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OhioHealth

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OhioHealth is a not-for-profit healthcare system headquartered in Columbus, Ohio, dedicated to providing exceptional patient care and a wide range of medical services. With facilities spread across multiple locations, OhioHealth offers comprehensive healthcare services including cancer care, maternity, midlife clinics for women, virtual health appointments, and specialized care for transgender and LGBTQ patients. They also focus on patient education with health and wellness classes, support groups, and health quizzes. OhioHealth is committed to improving community health through various community relations and health initiatives. They provide resources such as price transparency, financial assistance, and patient rights information to enhance the healthcare experience for all patients.

Healthcare • Home Care • Rehabilitation • Sports Medicine • Outpatient

10,000+ employees

Founded 1891

⚕️ Healthcare Insurance

🧘 Wellness

📚 Education

📋 Description

• Key individual in the Network Management department of the OhioHealth Clinically Integrated Network (CIN). • Manage and support the relationship between the physicians and payers in our network. • Manage current contracts on the physicians and the management of claims complaints and quality of care complaints. • Handle recruitment in areas that are identified as having a business need. • Negotiate fee schedules. • Audit payer rosters and update credentialing software (Cactus). • Verify and audit practice and demographic information for directory, website distribution, and claims payment. • Serve as strategic partner to providers and CIN payers. • Provide services to provider network offices for claims payment, product descriptions, education/training of staff and more. • Respond to external and internal customers’ inquiries, maintaining professional comportment. • Assist in provider recruitment for network participation and retention. • Communicate benefits of network participation to current and prospective network providers.

🎯 Requirements

• Bachelor's Degree • Degree or 5 years applicable experience in Health Insurance / Health Benefit Plan experience, or Healthcare provider experience (billing, claims, authorization, provider network relations, etc.) • Clear and concise verbal, written, eye contact, facial expression, and body language communication skills. • Attention to detail in practice. • Active listening skills. • Excellent documentation skills of customer needs, issues, problems. • Capability and use of qualifying skills regarding customers’ needs, issues, problems and getting their agreement on the items, as well as the timeline for health plan response(s). • Problem solving skills, as necessary, performed either individually, or in collaboration with others support and assistance. • Use of Microsoft office products, including but not limited to Word, Excel, Outlook (email, calendar, and contacts), and PowerPoint.