Provider Network Specialist jobs in Stroudsburg, PA
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
Network Prior Authorization & Referral Specialist
- St. Luke's University Health Network
-
Allentown, PA
PART_TIME
-
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.The Network Prior Authorization and Referral Specialist is responsible for the coordination of prior-authorizations and referral process for patients being referred for specialty care, diagnostic procedures, and surgery. Performs scheduling, insurance verification, obtaining pre-authorizations, and referrals. Ensures notification of reimbursement to physicians, nurses, financial clearance staff, and patients prior to services being rendered.JOB DUTIES AND RESPONSIBILITIES:
- Obtains prior-authorizations and referrals from insurance companies prior to procedure or testing utilizing online websites or via telephone
- Monitors and updates current Orders and Tasks; managing Orders through Allscripts and Epic to provide up to date and accurate information
- Provides insurance company with clinical information necessary to secure prior-authorization or referral
- Works in alignment with Central Scheduling and Pre Encounter Departments.
- Obtains necessary electronic referrals needed from scheduled specialty appointments
- Obtains and/or reviews patient insurance information and eligibility verification to obtain prior-authorizations for diagnostic testing, medications, injections, DME, and surgeries.
- Request retro-authorizations when needed.
- Communicates with patient regarding the visit and prior-authorization process.
- Provides support to physician group and community practices with utilization issues.
- Works with community practices to obtain prior-authorizations.
- Communicates with practices when prior-authorization is unable to be obtained and requires peer-to-peer and/or different study.
- Documents in all systems prior-authorizations to ensure proper reimbursement
- Verifies and completes patient eligibility, coverage verification, and benefit investigation for the procedure using an online application or by telephone. If the patient is not eligible on date of service or procedure is not covered, this information is relayed to the physician and the patient
- Responds to written and telephone inquiries from patients, insurance carriers and facilities regarding planned services.
- Takes an active role in facilitation team approach to functions within the department:
- Attends departmental meetings
- Actively participates as a team member in resolution of problems as they are identified
- Analyzes current procedures, bringing suggestions for improvement to the attention
- Contacts Central Scheduling, Patient Access Department, and patient, to relay precertification information
- Notify ordering physician of any prior auth denials and peer to peers to be scheduled
- Review and validate the accuracy of therapy plan/treatment plans ordered by reviewing H&P and medical records to ensure medication ordered is the same as what is being prior authorized
- Validate medication ordered is on the payer preferred drug list
- Identify buy and bill authorizations vs. delivery and document account accordingly
- Review and follow up on authorization denials and claim denials
PHYSICAL AND SENSORY REQUIREMENTS:Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephones, data entry, etc. Occasional twisting and turning. Uses upper extremities to lift and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve files. Hearing as it relates to normal conversation. Seeing as it relates to general vision. Visual monotony when reading reports and reviewing computer screen.EDUCATION:High School diploma or equivalent required.TRAINING AND EXPERIENCE:One to two years of experience in medical billing office, medical setting or insurance company. Working knowledge of medical business office procedures and basic accounting and detailed understanding of ICD-10 and CPT codes. Strong knowledge of regulatory standards and compliance requirements. Previous pre-certification experience helpful. Previous Medical Assistant experience highly desirable.Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!St. Luke's University Health Network is anEqual Opportunity Employer. -
- 29 Days Ago
Clinical Specialist in Robotics
- Good Shepherd Rehabilitation Network
-
Allentown, PA
FULL_TIME
- Good Shepherd is excited to add a Clinical Specialist in Robotics role to work in the Fleming Center for Robotics & Rehabilitation! In this role, the Clinical Specialist will implement advanced roboti...
- 18 Days Ago
Benefits/Payroll Specialist
- Good Shepherd Rehabilitation Network
-
Allentown, PA
FULL_TIME
- JOB SUMMARY Pays associates and compiles payroll information by coordinating and completing payroll preparation; completing reports; maintaining records; assists with benefit inquiries and processes. ...
- 2 Months Ago
Scheduling Specialist
- St. Luke's University Health Network
-
Allentown, PA
FULL_TIME
- St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisf...
- 29 Days Ago
Provider Talent Acquisition Sourcing Specialist
- St. Lukes Physician Group Inc
-
Allentown, PA
FULL_TIME
- St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisf...
- 15 Days Ago
Compensation specialist
- St. Luke’s University Health Network
-
Allentown, PA
FULL_TIME
- Workers Compensation Specialist page is loaded Workers Compensation Specialist Apply locations Allentown, PA - 1110 American Parkway time type Full time posted on Posted 2 Days Ago job requisition id ...
- 15 Days Ago
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0 Provider Network Specialist jobs found in Stroudsburg, PA area
Network Engineer
- firstPRO, Inc
-
Easton, PA
- firstPRO is seeking a qualified Network Engineer for our client, a large organization based out of Pennsylvania. They ar...
- 4/22/2024 12:00:00 AM
Network Engineer
- NetFire LLC
-
Hackettstown, NJ
- Job Type Full-time Description About NetFire NetFire is a New Jersey, USA based cloud technology company that specialize...
- 4/22/2024 12:00:00 AM
Network Engineer
- Netfire
-
Hackettstown, NJ
- Job Description Job Description Description: About NetFireNetFire is a New Jersey, USA based cloud technology company th...
- 4/22/2024 12:00:00 AM
Senior Network Engineer/ CCIE NJ or NC
- Blue Rock Consulting
-
Sparta, NJ
- Job Description Job Description Senior Network EngineerLevel: Senior/Non-Managerial Status: Full-TimeLocation(s): US-NJ ...
- 4/22/2024 12:00:00 AM
Lead Network Engineer
- Loop Internet
-
Scranton, PA
- Communications infrastructure is all around you; from the tower your cell phone talks to, to the point of sale systems a...
- 4/21/2024 12:00:00 AM
Network Engineer
- eTeam Inc.
-
Mountain Top, PA
- Job Description: Requirements " Experience in managing Cisco, and Client Network environments/technologies. " Cisco ACI ...
- 4/20/2024 12:00:00 AM
Network Engineer
- Firstpro Inc
-
Easton, PA
- firstPRO is seeking a qualified Network Engineer for our client, a large organization based out of Pennsylvania. They ar...
- 4/20/2024 12:00:00 AM
Network Engineer
- eTeam, Inc.
-
Mountain Top, PA
- Job Description: Requirements •Experience in managing Cisco, and Client Network environments/technologies. •Cisco ACI ex...
- 4/20/2024 12:00:00 AM
About Stroudsburg, Pennsylvania
Stroudsburg is a borough in Monroe County, Pennsylvania, United States. It is in the state's Poconos region, approximately five miles (8 km) from the Delaware Water Gap, at the confluence of the Brodhead, McMichaels and Pocono Creeks. It is in northeastern Pennsylvania. It is also the county seat of Monroe County. Stroudsburg is part of the East Stroudsburg, PA Metropolitan Statistical Area, which in turn is part of the New York combined statistical area. The population was 5,567 at the 2010 census.
Stroudsburg is located at 40°59′9″N 75°11′43″W / 40.98583°N 75.19528°W / 40.98583; -75.1952...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$59,109 to $88,367
Stroudsburg, Pennsylvania area prices
were up 1.5% from a year ago
were up 1.5% from a year ago
What does a Provider Network Specialist do?
Provider Network Specialist in Springfield, MO
As the liaison between provider and the health plan, candidates are tasked with ensuring improved revenue generated and patient quality score.
December 16, 2019
Provider Network Specialist in Stamford, CT
Previous experience in a network development, provider recruitment or provider contracting.
December 04, 2019
Provider Network Specialist in Fort Wayne, IN
In this position, employees will be expected to perform benefits analysis and create reports on provider performance to support the needs of the analysis found.
January 18, 2020