Provider Network Coordinator - Commercial & Government Programs

Wellmark, Inc. • Des Moines, IA

4h • Hybrid

About The Position

As a Provider Network Coordinator, you will provide high level administrative and operational support to the Government Programs & Commercial Network teams. You will serve as the centralized point of contact for monitoring, coordinating and delivering key work relating to the No Surprises Act (NSA) and the Independent Dispute Resolution (IDR) regulations. In addition, you will develop and maintain a positive business relationship with providers and assist with completing provider outreach to obtain additional documentation in support of other team initiatives. This role will require a proactive approach to partnering with various internal stakeholders to drive accurate and efficient resolution for Open Negotiation (ON), IDR and Surprise Billing requirements.

Requirements

• Bachelor's degree in health, business, or related field, or applicable work experience.
• 1+ years of work experience in a health care related environment.
• Demonstrated proficiency in using Microsoft products such as Word, Excel, Outlook, or PowerPoint.
• Demonstrated verbal and written communication skills with the ability to clearly and concisely articulate information to stakeholders.
• Proactive, resourceful self-starter with effective organizational skills and strong attention to detail. Adaptable and flexible with changing priorities.
• Analytical, problem solving, and workflow management skills.
• Ability to work both independently and collaboratively with project teams.
• Naturally curious, inquisitive, and willing to ask questions to achieve goals focused on the desired outcomes.

Nice To Haves

• Experience working in provider engagement.
• Experience working with medical records requests, HEDIS projects, and other quality or risk adjustment programs.
• Experience with government programs (Medicare, Medicare Advantage, Medicaid, etc.).

Responsibilities

• Work collaboratively with the Gov't Programs Network teams to support the deployment of strategies that support performance in Star ratings, risk adjustment and total cost of care.
• Partner with internal and external stakeholders and/or vendors in the maintenance of data files, extracts, and automated file transfer processes to support the reporting and analysis needs of the Network Performance team.
• Assist with the development of dashboards and performance summaries to monitor and track program initiatives, as well as performance of key healthcare organizations in value-based contracts and/or incentive programs.
• Coordinate the delivery of monthly provider reporting packages, including partnering with internal resources to ensure alignment on data sources, coordinating the monitoring of data validation and quality assurance checks, and collaborating with Network Performance team on timely and secure delivery to key health care organizations.
• Use organizational skills to document, track, monitor and drive activities to ensure effective coordination of internal and external resources and completion of expected outcomes, deliverables and/or milestones.
• Provide operational support to Network Performance team as they work with providers, assisting in the documentation of best practices, workflows, and processes.
• Support development of internal process documents and ongoing maintenance.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level