Provider Network Specialist-255100 at Medix Provider Network Specialist-255100 at Medix in Union City, New Jersey Posted in about 18 hours ago.

Type:

full-time

Job Description Responsibilities:

Actively communicate with prospective and contracted providers based on business needs. Guide prospective providers through the application, credentialing, contracting, and onboarding processes. Conduct prospective provider site visits, as applicable. Facilitate new provider orientations and ongoing provider education and training. Foster and maintain positive provider network relationships. Develop and strengthen relationships with providers, office staff, and key stakeholders. Maintain accurate provider contact information, including key contacts within credentialing, claims, contracting, quality, population health, and provider operations. Manage an assigned provider territory, including strategic network partnerships and provider engagement initiatives. Serve as a primary point of contact for providers, offering support regarding network participation, provider resources, directory accuracy, operational processes, claims inquiries, and reimbursement questions. Schedule and conduct provider office and facility visits in accordance with departmental goals and outreach initiatives. Investigate, resolve, and respond to provider inquiries related to participation requirements, credentialing status, contract terms, reimbursement, claims, utilization, access and availability standards, member eligibility, and provider data management. Document, track, and monitor provider issues through resolution in accordance with organizational policies and procedures. Collaborate across departments to resolve complex provider concerns and identify trends impacting provider satisfaction and network performance. Partner with business development, marketing, and community outreach teams to support network growth and provider engagement efforts. Prepare and analyze reports related to network adequacy, provider access, and network performance. Monitor provider contract performance and network effectiveness through site visits, claims data, and performance analytics. Support quality improvement initiatives and ensure compliance with applicable regulatory and organizational standards. Collaborate with Quality and Population Health teams to promote quality measures, improve provider performance, and enhance patient outcomes. Perform additional duties and special projects as assigned.

Required Skills:

Proficient in Microsoft Office Suite, including Word, Excel, PowerPoint, Access, and Salesforce. Strong organizational skills with exceptional attention to detail. Effective presentation and public speaking skills. Accurate and efficient data entry and record management abilities. Ability to manage multiple priorities, adapt to changing business needs, and meet strict deadlines. Strong verbal and written communication skills, with excellent analytical and problem-solving abilities. Knowledge of healthcare, medical, and managed care terminology. Must have a car and valid driver's license.

Schedule:

Monday-Friday, 9:00 AM - 5:00 PM (35-hour work week). During the first 4-5 months, the schedule will be hybrid:

Monday and Friday:

Remote Tuesday, Wednesday, and Thursday:

In-office Following the onboarding and training period (approximately 4-5 months), the hybrid schedule will remain in place; however, the role will also include in-person provider visits and meetings.

Monday and Friday:

Remote work and/or field-based provider visits

Tuesday, Wednesday, and Thursday:

In-office