Network Internal Representative

Community Health Network of Connecticut, Inc. • Wallingford, CT

8d • $20 - $26

About The Position

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Network Internal Representative to join their team. This role primarily involves data entry and systems maintenance for provider/hospital files, supporting external representatives, and updating the online directory. The position also provides direct support in resolving member/provider financial grievances, conducting outreach to providers, and preparing reporting documentation. The role requires adaptability in a fast-paced environment and proficiency in specific software systems.

Requirements

• High school diploma or GED required
• 5 years related experience in Medicaid and associated administrative practices
• at least 3 years of demonstrated proficiency handling customers and/or providers via telephone or electronic email
• Knowledge of the Connecticut health care delivery system.
• Knowledge of Medicaid Program and demonstrated skills performing administrative practices (purchase vouchers, scheduling meetings)
• Knowledge and ability to perform and learn various software programs.
• Proficient with Microsoft Office suite including Word, Excel (including basic formulas, sorting, filtering, etc.), Outlook, PowerPoint, CRM, Interchange, and CACTUS/sProvider.

Nice To Haves

• College level degree preferred
• General studies; business courses

Responsibilities

• Under the supervision of the Manager, Provider Engagement Services (PES), performs data entry and systems maintenance for provider/hospital files in CACTUS/sProvider data management system.
• The Internal Representatives basic function is to support the External PES Representatives while they are onsite at Connecticut Medical Assistance Program (CMAP) network provider locations.
• Network Internal Representatives also update and maintain provider/hospital files in CACTUS/sProvider for the member/provider on‑line directory.
• Provide direct support in Member/Provider Financial Grievance resolution by reviewing member eligibility and claims.
• Outreach CMAP providers when members are billed and follow up with members via email on grievance resolution.
• Provide reporting support documentation.
• Performs other duties as assigned by the VP of Population Health and/or Manager of PES.
• Verifies, analyzes, and maintains all provider/hospital data in support of member/provider directory for assigned region(s).
• Daily duties include telephonic and email recruitment of instate and out-of-state providers through tasks sent by the Member Engagement Services Call Center.
• Performs telephonic and email recruitment of all Ordering, Prescribing and Referring (OPR) providers sent by DSS.
• Telephonic and email recruitment of Connecticut Medical Assistance Providers (CMAP) who are to re-enroll within 60‑days of DSS termination date.
• Telephonic and email outreach of CMAP providers that are terminated from the network to reenroll and track termination reasons.
• Monitor CRM for provider-related financial grievances and inquiries and provide a timely response if needed.
• Input data into CRM from Tasks and Grievances.
• Aid in the identification of Primary Care Providers (PCP) through PCP attribution reports and collaborating with the Quality Management Person-Centered Medical home team.
• May be called upon to perform problem resolution and company operating policy guidance to hospital, physician, and other designated providers in the CMAP network.
• Must be able to adapt to a fast paced, changing work environment.
• The ability to update and query in CACTUS/sProvider is an important part of the job responsibility.

Benefits

• We are dedicated to having a workplace where everyone feels valued, respected, and empowered to succeed.
• We embrace a wide range of perspectives and backgrounds, ensuring fair treatment and opportunities for all employees.
• We value our team’s rich array of experiences and viewpoints, which contribute to our innovative and collaborative environment.
• We are committed to providing an inclusive and accessible interview process. If you require a reasonable accommodation for your interview due to a disability. Please contact us in advance if you need an accommodation.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED