Provider Network Specialist jobs in New Mexico
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
- UNM Hospitals
-
Albuquerque, NM
FULL_TIME
-
Department: Provider Network Development
FTE: 1.00
Full Time
Shift: Days
Position Summary:
Manage negotiation, operation, and administration of liaison activities associated with healthcare provider contracting for the TriWest Veteran Administration (VA) Community Care Network (CCN) for the state of New Mexico. Develop and deliver provider education for participant facilities and individual physicians, in compliance with CCN program requirements, and conduct research into claims, referral and authorization, and other operational issues related to provider contracting and networking. Ensure adherence to Hospitals and departmental policies and procedures. No patient care assignment.
Detailed responsibilities:
- NETWORK RELATIONS - Manage the negotiation of individual network contracts with hospitals, physician groups, and other health care related agencies and companies in New Mexico and West Texas
- NETWORK RELATIONS - Manage negotiation of various contract rates and reimbursement methodologies for all network agreements, ensuring compliance with the VA, TriWest, Medicare, or industry regulations, as appropriate
- NETWORK RELATIONS - Oversee the negotiation and establishment of contract language and legal requirements in compliance with VA and Triwest requirements, University policies, industry standards and other Federal laws and regulations
- NETWORK RELATIONS - Serve as primary interface and liaison with TriWest CCN network administration, management, and staff, as needed to execute contracts, resolve contractual problems and issues, and provide information and instruction
- NETWORK RELATIONS - Plan, develop, and deliver education programs for network entities on all aspects of CCN requirements, to include program administrative guidelines, operational processes, billing, credentialing and certification, and related issues
- RESOURCE - Serves as primary operational liaison with the TriWest Corporation; independently oversee key operational activities between NM Providers and Triwest, to include referral and authorization operations, claims adjudication, educational activities, and planning for network providers to meet VA staffing requirements
- PROCESS IMPROVEMENT- Research and assess CCN network needs and develop strategies to meet network operational requirements and goals; analyze issues such as provider and coverage needs and data access standards in support of contracting and network development strategies
- ISSUE RESOLUTION - Provide oversight and primary liaison services between CCN network providers and the identified claims payment administrator for the program; identify claims payment issues and/or trends and coordinate resolution of problems and issues with the payer
- ISSUE RESOLUTION - Represent network entities in individual discussions with the claims payment administrator and TriWest; analyze Explanation of Benefits documents received from the administrator and/or Medicare, and resolve individual payment problems and issues, as they arise
- OTHER - Perform miscellaneous job-related duties as assigned
- COMMUNICATIONS – Maintain and update all provider and institutional contract and credentialing application documents; create and share spreadsheets for tracking current contracting statuses; plan, develop, implement and update the UNMH CCN internet web page, including links for provider resources
- DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops
Qualifications
Education:
Essential:
- Bachelor's Degree
Essential:
- Related Discipline
Experience:
Essential:
3 years directly related experience
Nonessential:
No preferred experience
Credentials:
Essential:
- Not Applicable/Not Required
Physical Conditions:
Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Working conditions:
Essential:
- No or min hazard, physical risk, office environment
- 25 Days Ago
- UnitedHealth Group
-
Albuquerque, NM
FULL_TIME
- At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people fo...
- 11 Days Ago
- Innovative System Group
-
Albuquerque, NM
CONTRACTOR
- This position is responsible for the analyzing, researching, and applying business rules to complete requests received from providers regarding adds/deletes/changes to their information used for claim...
- 15 Days Ago
- Las Cruces Public Schools
-
Las Cruces, NM
FULL_TIME
- JobID: 11749 Position Type: Technology Date Posted: 9/12/2022 Location: Information Technology Closing Date: 09/14/2022 LCPS Employee Applicants Only Minimum Qualifications 1. Experience with advanced...
- 17 Days Ago
- North Central New Mexico Economic Development District
-
Santa Fe, NM
FULL_TIME
- Job Opportunity JOB TITLE: Provider Specialist SALARY RANGE: Based on experience and qualifications JOB DESCRIPTION: This position will be responsible for assisting with oversight of Non-Metro Area Ag...
- 1 Month Ago
- Abacus Solutions Group, LLC
-
Artesia, NM
FULL_TIME
- DescriptionAbacus Solutions Group: We're built on our shared core values! We are difference-makers, passionate about serving, we work hard with integrity and do the right thing. Difference makers mean...
- 25 Days Ago
Provider Network Specialist jobs at Popular Companies
- 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
- General Dynamics Information Technology
-
Camp Smith, HI
- Please take this opportunity to join one of GDIT's fastest long-standing growing programs! US Battlefield Information Co...
- 4/18/2024 12:00:00 AM
- Robert Half
-
Torrance, CA
- Two Network Roles: Network Engineer / Network Admin Location: South Bay (On-site with 40% travel) Target Salary: $100,00...
- 4/16/2024 12:00:00 AM
- Leidos
-
Undisclosed, MD
- Description Join a long-term prime program with new positions and strong leadership. The Cyber & Analytics Solutions tea...
- 4/5/2024 12:00:00 AM
- 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
- 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
- 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
- Leidos
-
Columbia, MD
- Description Provides assistance in all aspects of network management from network design through implementation, mainten...
- 2/6/2024 12:00:00 AM