Provider Network Specialist jobs in Mississippi
Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Provider Network Specialist jobs
BlueAdvantage Network Provider Consultant
- Blue Cross & Blue Shield of Mississippi
-
Flowood, MS
FULL_TIME
- Healthy Careers Start Here At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellness at all levels of the Company, and we provide our employees with the time, tools and resources to commit to a healthy lifestyle. Job Summary The BlueAdvantage Network Provider Consultant serves as a consultant and corporate liaison to BlueAdvantage Network Providers, including, but not limited to professional, facility, and allied providers. This role provides consultative services to the BlueAdvantage Network Provider community to ensure compliance with BlueAdvantage contracts and performance expectations. This includes sharing of Network Provider performance against BlueAdvantage requirements, Centers of Medicare and Medicaid Services (CMS) rules for STARS ratings and clinical improvement of patients to include HEDIS improvement and gaps in care closure. The BlueAdvantage Network Provider Consultant will also be responsible for ensuring Network Provider compliance to improve administrative and clinical efficiency/effectiveness to assist in providing the highest quality and most cost effective healthcare to BlueAdvantage Members. Job-Specific Requirements: · A Bachelor’s degree in Business Administration, Health Administration, or Nursing. · At least three (3) years of professional healthcare experience and must possess knowledge of member and provider contract benefits, clinical guidelines, medical policy and claims processing for designated line(s) of business, or possess equivalent healthcare related industry knowledge. · Medicare Advantage benefit plans experience. · Experience in working with healthcare providers on improvement in Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. · Experience with and knowledge of Medicare STARS program to measure health plan and healthcare provider performance. · Knowledge of the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) risk adjustment model. · Exhibits professional and positive demeanor with excellent communication. · Excellent verbal and written communication skills including exemplary presentation skills, development of correspondence, review and management of performance documents etc. · Ability to travel throughout the state to meet with BlueAdvantage Network Providers. · Demonstrated proficiency in Microsoft Office Suite, especially Excel, Word and PowerPoint. Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers. At Blue Cross & Blue Shield of Mississippi, we work daily to help Mississippians find their personal answers to this question through health and wellness partnerships with quality healthcare providers, employer groups and community leaders across the state. Our goal is to help each person along their journey to a healthier life… their Blue Wellness Journey. Our health and wellness benefits are designed to support our members in understanding their health and in receiving the care they need at the right time and place, beginning with establishing a healthy relationship with a Primary Care Network Provider through an annual wellness visit at no out-of-pocket cost. We partner with our Network Providers to ensure the highest quality, evidence-based care is provided in each care setting from primary care to specialty care through our Primary Care Home, Blue Distinction Centers of Excellence and Maternity Care Quality initiatives. We partner with employer groups to make every workplace a healthy workplace by providing tools and information to help employees take ownership of their health and understand and make the most of their benefits, all while working to manage health and healthcare costs. We partner with community leaders and organizations to make healthy living resources available to all Mississippians through the work of the Blue Cross & Blue Shield of Mississippi Foundation, our support of the arts and culture and our Team Blue volunteers. These partnerships and our dedicated team of employees are making a difference every day, in our communities and in the lives of each person we reach. So, what does it mean to be healthy? The answer is about you, your health, your life… and all its possibilities. Live healthy. Live Blue.
- 1 Month Ago
Network Infrastructure Specialist II
- MS Dept. of Revenue
-
Clinton, MS
FULL_TIME
- This position works in close cooperation with internal and external contributors to troubleshoot and maintain network and communication systems of moderate complexity to support workloads. Additionall...
- 26 Days Ago
Network Infrastructure Specialist IV
- MS Dept. of Revenue
-
Clinton, MS
FULL_TIME
- This position is responsible the lifecycle of network architectures and design of complex infrastructure platforms. Additionally, this position establishes network standards, platforms, protocols, and...
- 26 Days Ago
Provider Credentialing Specialist
- Blue Cross & Blue Shield of Mississippi
-
Flowood, MS
FULL_TIME
- Healthy Careers Start Here At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellnes...
- 1 Month Ago
Caregiver
- The Goode Provider
-
Southaven, MS
FULL_TIME
- Responsible for administrative as well as clinical tasks, such as maintaining patient records, preparing patients and rooms for examination, assisting providers with exams, and performing front-desk t...
- 14 Days Ago
Jr. Computer Network Support Specialist
- Martek Global Services Inc.
-
Vicksburg, MS
FULL_TIME
- The U.S. Army Research Laboratory hosts some of the fastest supercomputers in the world and we are seeking a highly motivated, self-starting individual interested in this fast-paced challenging opport...
- 17 Days Ago
Provider Network Specialist jobs at Popular Companies
Network Engineer
- Leidos
-
Columbia, MD
- Description Provides assistance in all aspects of network management from network design through implementation, mainten...
- 4/19/2024 12:00:00 AM
Network Engineer
- Leidos
-
Arlington, VA
- Description At Leidos, we deliver innovative solutions through the efforts of our diverse and talented people who are de...
- 4/19/2024 12:00:00 AM
Network Engineer
- Leidos
-
Lanham, MD
- Description At Leidos, we deliver innovative solutions through the efforts of our diverse and talented people who are de...
- 4/19/2024 12:00:00 AM
Network Engineer
- Leidos
-
Washington, DC
- Description At Leidos, we deliver innovative solutions through the efforts of our diverse and talented people who are de...
- 4/19/2024 12:00:00 AM
Network Engineer
- General Dynamics Information Technology
-
- Please take this opportunity to join one of GDIT's fastest long-standing growing programs! US Battlefield Information Co...
- 4/19/2024 12:00:00 AM
Network Engineer
- Leidos
-
Reston, VA
- Description Join us at Leidos, where your most important work is ahead! You will enjoy great benefits such as paid time ...
- 4/3/2024 12:00:00 AM
Network Engineer
- Leidos
-
Annapolis Junction, MD
- Description Leidos is looking for a Mid-Senior Level Network Engineer to join a high performing agile team using the Sca...
- 3/13/2024 12:00:00 AM
Network Engineer
- Leidos
-
Fort Meade, MD
- Description Are you ready to make an impact and join a creative, forward-thinking team? We’re looking for innovators and...
- 3/7/2024 12:00:00 AM
About Mississippi
Mississippi is bordered to the north by Tennessee, to the east by Alabama, to the south by Louisiana and a narrow coast on the Gulf of Mexico; and to the west, across the Mississippi River, by Louisiana and Arkansas.
In addition to its namesake, major rivers in Mississippi include the Big Black River, the Pearl River, the Yazoo River, the Pascagoula River, and the Tombigbee River. Major lakes include Ross Barnett Reservoir, Arkabutla Lake, Sardis Lake, and Grenada Lake with the largest lake being Sardis Lake.
Mississippi is entirely composed of lowlands, the highest point being Woodall Mountai...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$52,151 to $77,966
Most Popular Cities in Mississippi for Provider Network Specialist Jobs
What does a Provider Network Specialist do?
Provider Network Specialist in Anderson, IN
Creates, maintains, and ensures the integrity of the provider data in DHP’s multiple claims payments systems and provider interface programs.
January 07, 2020
Provider Network Specialist in Tucson, AZ
Identifies and works with the provider to address education needs relative to DHP’s new product lines/expansions, utilization management, claims submission, and back-end issues resolution requirements of each assigned provider’s contract.
January 12, 2020
The Provider Network Specialist will work closely with all facets of the business, primarily with Care Management, Claims and Business Development.
January 08, 2020
Provider Network Specialist in Oakland, CA
Build and maintain a successful working relationship with Integra Managed Care and network providers.
December 03, 2019