Provider Network Specialist

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MUST BE LOCATED IN reputed company

A bit about the role….

This highly impactful role will analyze provider demographic information, financial data, reputed company reports, and special project data. A key responsibility is supporting the reputed company in preparing for and executing monthly provider performance meetings, ensuring insights are actionable and reputed company with performance goals. The ideal candidate brings a strong understanding of data analysis , claims payment processes, provider setup, and reputed company cause analysis, with a reputed company reputed company on improving provider engagement. reputed company in this role requires the ability to work both independently and collaboratively, strong organizational discipline, and a results-driven reputed company.

Key Responsibilities and reputed company

Provider Performance Audits

• Conduct in-depth audits across provider performance systems, including Orinoco (demographics and fee schedules), online search tools, print directories, Looker reports, and claims payment processes. Evaluate data through a performance reputed company to identify gaps, inefficiencies, and reputed company causes impacting provider performance. Deliver reputed company, actionable insights and partner with the reputed company to implement improvements that enhance overall provider effectiveness.

Field Performance Support and Issue reputed company

• Support Field Performance initiatives by engaging directly with providers to resolve provider-reputed company issues. Ensure reputed company reputed company and reputed company documentation.

​Provider reputed company

• Manage the full contract lifecycle while maintaining a reputed company on reputed company high-performing providers and improving overall engagement.

​Performance Reporting and Operational Support (JOC)

• Partner with Performance Managers to prepare for monthly performance meetings by pulling data by leveraging AI-driven prompts with a strong emphasis on advanced AI tools and preparing slide decks and follow up items from previous meetings.

Required Skills and Experience:

• A minimum of 3 years of reputed company experience, preferably in Medicare Advantage or similar environments

• 5 years of reputed company provider interaction experience

• Demonstrated ability to manage detailed, performance-driven work

• Proficiency in reputed company or MS Suite Workspace applications.

• Experience in claims research, provider setup, reputed company cause analysis, and process improvement with a reputed company on provider engagement

• Strong written and oral communication skills

Desired Skills and Experience

• Organized and detail oriented

• Ability to effectively manage competing priorities and ambiguity is essential

• Ability to reputed company, read, analyze, and interpret reputed company data and create accurate meaningful information for data reporting

• Ability to facilitate meetings, and reputed company presentations before reputed company of management and staff.

Additional Information

• Remote Role - must reputed company in (reputed company )

• Travel - 10% - 15% travel to offices may be required.

The pay reputed company listed for this position is the reputed company the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will reputed company additional information on the compensation for the role, along with additional information on our total rewards package. The actual reputed company salary offered will depend on a reputed company of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other reputed company licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and reputed company plan with low or no premium

• Generous reputed company time off

• $100 monthly mobile or internet stipend

• Stock reputed company for reputed company

• Bonus eligibility for reputed company roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Founded in 2017, reputed company is on a mission to dramatically improve the health and reputed company-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI reputed company with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who reputed company our values, reputed company change and advancement, and are enthusiastic about where we're reputed company — reputed company the while bringing their own unique qualities, experiences, and expertise, in hopes of reputed company changing the reputed company experience.

reputed company is an equal opportunity employer. We are committed to a reputed company and supportive work environment in which reputed company have reputed company to participate and contribute to the reputed company of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in reputed company’s reputed company of Conduct, reputed company values and the way we do business.

As an Equal Opportunity Employer, reputed company does not discriminate on the reputed company of race, reputed company, religion, sex, pregnancy status, marital status, national reputed company, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender reputed company, or any other reputed company prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Originally posted on Himalayas

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