Network Specialist
Devoted Health
full-time
Posted on:
Location Type: Remote
Location: Colorado • United States
Visit company websiteExplore more
Salary
💰 $65,000 - $75,000 per year
About the role
- Auditing functions: provider set up in Orinoco (demographic and fee schedules), online search tool, print directory, Periscope reports, claims payment.
- Determine root cause of issues and recommend process improvements.
- Provide clear analysis and next steps for network team.
- Analysis of network grievances, determination of track and trend or provider outreach, complete outreach as needed, prepare monthly reporting.
- Contracting to support network adequacy in existing and expansion counties.
- Contract processing, to include: obtaining contract signatures, preparing provider rosters, submitting contract load form.
- Assistance with Field Network cases, outreach to providers, documentation of resolution.
- Evaluate participation requests against network need, current contractual relationships, expansion efforts, access to care.
- Make recommendations to management.
- Contract as needed.
- Respond accordingly to providers.
- Assist network managers with monthly JOC meeting preparations, research outliers in financial reports, audit reports for accuracy, assist with follow up items from meetings.
Requirements
- 3+ years of direct provider interaction
- 3+ years healthcare experience with medicare advantage or other relevant experience.
- Proven track record of detail oriented work
- Ability to navigate Google or MS Suite of products.
- Experience in claims research, provider set up, root cause analysis, process improvement.
Benefits
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims researchprovider set uproot cause analysisprocess improvementcontract processingdata analysismonthly reporting
Soft Skills
detail orientedclear communicationproblem solvingrecommendation making