Provider Network Specialist, Physical Health Enrollment/Maint
Partners Health Management
Provider Network Specialist, Physical Health Enrollment/Maint
Partners Health Management
full-time
Posted on:
Origin: • 🇺🇸 United States • North Carolina
Visit company websiteSalary
💰 $51,367 - $64,209 per year
Job Level
Mid-LevelSenior
About the role
- This position assists in the enrollment, maintenance, development and management of the Provider Network for consumers who have been identified as having mental health, substance use or intellectual development disability needs.
- Provide support to internal and external stakeholders to resolve provider data issues.
- Research and effectively respond to provider data related issues.
- Track, update and audit provider data.
- Work with other departments on cross-functional tasks and projects.
- Completes special projects as assigned.
- Collaborate with health plan regarding compliance with provider set up and validation for all network requirements through data review, monitoring and collaboration.
- Attention to detail and adherence to strict timelines; must be able to work independently and use good judgement in making critical decisions that impact service availability inside the Partners network.
- Manage and foster solid collaborative relationships with external stakeholders and internal department leaders to develop the innovation and recommendations for next steps.
- Assess and manage risk throughout all aspects of the solution design and development and escalates as needed.
- Monitor progress, reports results/outcomes and adjusts as needed.
- Interpret audit results, identifies trends/patterns that impact service/system quality, and then implements interventions aimed at addressing these trends/patterns with the outcome of services delivery to consumers at the highest degree of quality cross functional team activities.
- Provide appropriate reports and statistical data to other department designees for review, follow-up and resolution.
- Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements.
- Evaluate risks and concerns and communicate to management.
- Serve as the subject matter expert on provider set up and validation to ensure operational performance.
- Resolve issues and identify opportunities for process redesign and improvement.
Requirements
- Bachelor’s Degree in mental health, public health, social work, psychology, education, sociology, business or public administration and five (5) years of experience in a community, business, or governmental program in health-related fields, social work or education including experience in network operations, provider relations and management experience.
- A combination of relevant experience may be considered in lieu of a bachelor’s degree.
- Must have ability to travel as needed to perform job duties.
- NC Residency is required.
- Master’s Degree in mental health, public health, social work, psychology, education, sociology, business or public administration and two (2) years of experience in a community, business, or governmental program in health-related fields, social work or education including experience in network operations, provider relations and management experience.
- Licensure/Certification Requirements: N/A
