Provider Network Support Specialist

Job Summary: The Network Support Specialist is responsible for negotiating Single Case Agreements for out of network and out of area services, monitoring the daily operations within the Contracting Department, ensuring complete and accurate information is provided on all inquiries and deadlines are met per established departmental policy. Ability to develop and implement processes for better work flows within the Contracting Department. The Network Support Specialist must possess the ability to work in a team environment, work independently with minimal guidance, demonstrate excellent verbal and written communication and organizational skills. Must have excellent interpersonal skills and be able to work with all levels of management and staff, both technical and non-technical. Strong, independent decision-making abilities are required. Must be able to conduct research, be resourceful, and self-reliant. Ability and willingness to learn the business and operating environment within the Health Plan. Must be able to handle multiple tasks, set priorities, meets deadlines, and work well under pressure. Proficient with M/S office, including Excel, Word, Access, PowerPoint, and Outlook. Heavy computer and telephone work. Demonstrate the ability to maintain a positive, customer-focused, and professional attitude.

Job Requirements

Regulatory Requirements:

• Associates degree or equivalent work experience.

• Minimum 3 years' experience in healthcare such as medical claims, medical front/back office, contracting or Provider Relations preferred

• Enjoys working in both individual and team settings

• Must be able to work independently; providing management with status updates

• Experience in working with QNXT, Impact and/or any claim processing application is preferred

Language Skills:

• Ability to effectively communicate in English, both verbally and in writing.

Skills:

• Proficient in Microsoft Office skills (Excel, Word, Access,etc.)

• Multi-task; establish priorities

• Self-starter, resourceful and able to execute projects in a fluid and fast paced environment

• Good communication and relationship skills

• Strong analytical skills

• Attention to detail