Robert Half Office Team Provider Network Relations Specialist in MECHANICSBURG, Pennsylvania

Provider Network Relations Specialist

  • Position Purpose: Perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as liaison between providers and the health plan to enhance the business relationship. Duties of the Provider Network Relations Specialist

  • Conduct initial provider orientations as well as ongoing educational outreach

  • Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface

  • Enhance account relationships by investigating, documenting and resolving provider matters and effectively handling and responding to account changes and correspondence.

  • Engage providers and educate them on Patient Centered Medical Home initiatives

  • Perform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and create reports for provider Review provider performance by both quantitative metrics and qualitative factors

  • Create and communicate milestone documents, dashboards and success or improvement metrics

  • Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance

  • Provide information and status updates for providers regarding incentive agreements

  • Conduct site visits when required

  • Perform other contracting duties as requested, including but not limited to recommending changes to pricing subsystems, submitting changes to provider related database information and assisting in the completion of special projects

  • Ability to travel Requirements: Bachelor's degree in related field or equivalent experience. 2+ years of combined managed healthcare and provider reimbursement experience. Advanced knowledge of Microsoft Excel. Clinical or health information management (HIM) experience preferred. Claims processing and/or managed care experience preferred. Licenses/Certifications: Current state driver's license.

OfficeTeam is the world's leader in quickly matching skilled administrative professionals with temporary and temporary-to-full-time jobs. We offer job opportunities ranging from executive and administrative assistants to customer service representatives, receptionists and general office support. Our staffing managers connect with more than 100,000 hiring managers in North America every single week. In addition to free job search services, we provide access to free online skills training and a competitive benefits and compensation package.

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Equal Opportunity Employer M/F/Disability/Vet

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Req ID: 03750-0008945490

Functional Role: Administrative - Medical

Country: USA

State: PA


Postal Code: 17055-6922

Compensation: $20.00 to $28.00 per hour

Requirements: MS Excel, Report Generation, Prepare Presentations, Training - Presentation, Benefits Coordination, Benefits Administration