The Network Relations role supports the frontline of Network Development, responsible for providing excellent customer service while impacting and overseeing provider data integrity. This role must combine strong interpersonal skills with an aptitude in the medical provider market. This can be a hybrid or remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Assist Developer with implementing medical providers, using written and verbal communication Verify all provider signatures, contracts and documentation before submitting for internal processing Review credentials of prospective providers to be considered for acceptance into network per national credentialing requirements and protocols Provide orientation on managed care procedures and establish liaison(s) with all participating providers Assist and communicate with provider orientation program in cooperation with Developer Distribute and maintain provider manual and orientation materials per state guidelines Receive and resolve all disputes involving provider contract and payment issues in accordance with contract Dispute Resolution Procedures Provide assistance and respond to staff requests for information regarding the network, both locally and nationally Oversee distribution of executed contracts and maintenance of database Assist with network marketing, employer and payor relations and product development Conduct and manage provider data audits that ensure data integrity for network and oversee all provider updates and changes with NDB Coordinate and process provider roster updates at least annually or as otherwise required Perform facility site surveys as needed per credentialing requirements or state guidelines Identify specialties within network and generate a recruitment list for Developer Additional duties as assigned KNOWLEDGE & SKILLS: Strong interpersonal skills and adaptive communication style Complex problem solving skills and innovation Ability to quickly adapt to process changes Ability to prioritize and manage assignments, scheduled or unscheduled Ability to embrace new tools and procedures per corporate guidelines and objectives Strong organizational skills Excellent written and verbal communication skills Superb attention to detail and ability to deliver results in a fast paced and dynamic environment Proficient in Microsoft Office applications EDUCATION & EXPERIENCE: Associate’s degree or two or more years of equivalent work experience Customer service education/training within the insurance industry, managed care or related field
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Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree