Provider Network Specialist

October 14

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OhioHealth

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Healthcare • Home Care • Rehabilitation • Sports Medicine • Outpatient

10,000+

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. • Handle recruitment in areas that are identified as having a business need, and negotiations of their fee schedules. • Audit payer rosters, update credentialing software (Cactus) after committee approval and verify and audit practice and demographic information is correct for directory, website distribution, and claims payment. • Liaison between departments within OhioHealth for contracting and network product questions/issues.

Requirements

• Bachelor’s 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.