Provider Network Specialist Position Available In Miami-Dade, Florida

Provider Network Specialist Premier Physician Support Services, LLC Miami, FL Job Details Full-time $60,000 – $75,000 a year 6 hours ago Benefits Health savings account Employee discount Life insurance Qualifications Network administration Medical claims Microsoft Excel Management Managed care Mid-level Bachelor’s degree Network management 2 years Communication skills Full Job Description

JOB DESCRIPTION

Job Summary Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims, Credentialing and provider databases. This multifaceted role supports both operational efficiency and strategic project delivery for process improvement initiatives as it pertains to other provider network management areas.

KNOWLEDGE/SKILLS/ABILITIES

Bridge communication and collaboration between IT, provider network teams and business end users to align objectives and drive coordination of project delivery activities Ability to track and maintain provider Credentialing profiles and enrollments. May attend and lead meetings with payors Track and manage all payor contracts Responsible for ensuring all clinic physicians credentialing with payors and regulatory bodies are current and up to date. Lead efforts in identifying and analyzing workflow inefficiencies, recommend process improvements, and collaborate with cross-functional teams to design and implement optimized solutions that enhance operational performance and productivity. Deliver customer-focused support and training to ensure smooth project delivery, successful adoption and effective utilization of implemented solutions. Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/Provider Inquiry Research & Resolution, Provider Contracting/Provider Relationship Management/Credentialing). Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and Network Management business operations. Generates other provider-related reports, such as claims report extractions; Capitation review, regularly scheduled reports related to Network Management and mailing label extract generation. Develop and maintain documentation and guidelines for all assigned areas of responsibility.

JOB QUALIFICATIONS

Required Education Bachelor’s Degree or equivalent combination of education and experience Required Experience 3-5 years managed care experience, including 2+ years in Provider Claims, Credentialing and/or Provider Network Administration. Access and Excel – intermediate skill level (or higher) Preferred Education Bachelor’s Degree Preferred Experience 5+ years managed care experience including

Credentialing Network Administration Job Type:

Full-time Pay:

$60,000.00 – $75,000.00 per year

Benefits:

Employee discount Health savings account Life insurance

Schedule:

8 hour shift Monday to Friday Application Question(s): Do you have a minimum of 3 years of managed care experience? Do you have a minimum of 2 years experience in provider claims, credentialing or provider networks?

Work Location:

Hybrid remote in Miami, FL 33183