Provider Network Consultant II

Medica • St Louis, MO

2d • Onsite

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. Provider Network Consultant develops and maintains assigned provider relationships. Reviews provider requests for inclusion in assigned territories and assists in analyzing impact to determine approval. Manages on-going provider needs relative to program roll-outs and medical policy change communication. Provides onboarding education/outreach, handles provider appeals, and resolves escalated provider issues. Ensures that provider data is accurate.

Requirements

• Bachelor's degree or equivalent experience in related field
• 3 years of health plan or provider experience
• Advanced level Microsoft Excel skills
• Strong attention to detail
• Aptitude to learn multiple systems
• Strong written and verbal communication skills with a proven track record of follow-up
• Problem solving and research skills
• Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

Nice To Haves

• Experience with claims operations and various reimbursement methodologies strongly preferred
• Experience managing and loading provider rosters preferred

Responsibilities

• Develops and maintains assigned provider relationships.
• Reviews provider requests for inclusion in assigned territories and assists in analyzing impact to determine approval.
• Manages on-going provider needs relative to program roll-outs and medical policy change communication.
• Provides onboarding education/outreach
• Handles provider appeals
• Resolves escalated provider issues.
• Ensures that provider data is accurate.

Benefits

• competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees