Provider Network Specialist jobs in Texas

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)

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Provider Network Development Specialist
  • Apex Health Solutions
  • Houston, TX FULL_TIME
  • Summary
    Position is responsible for network development and adequacy activities including but not limited to: provider data analysis and integrity, maintenance of provider roster, regulatory reporting production, and supporting both product and geographic expansion efforts.  This role helps to support several workflow processes within the network development team and will need to be comfortable working with other team members and departments.  Typically reports to a Network Operations Leader.


    Essential Functions
    • Responsible for provider research, analysis, & data maintenance to ensure viable and adequate provider network(s)
    • Supports the network development team with provider outreach and contracting processes
    • Obtains and maintains required documentation from providers that have been targeted for network adequacy
    • Consistently monitors network adequacy status and reporting in comparison with applicable requirements and business initiatives
    • Provides ongoing support to network management and other internal stakeholders as appropriate
    • Composes all correspondence and contract information concisely and accurately, in accordance with regulatory requirements
    • Maintains well-organized, accurate, and complete files for all provider data, contracts, outreach, correspondence, outcomes, and supports the accuracy of the network management contract database
    • Monitors each request to ensure all internal and external regulatory timelines are met
    • Collaborate with internal and external stakeholders to ensure prompt and appropriate action is taken regarding provider network development related activities
    • Supports network development activities and initiatives to support improvement in network performance
    • Assists in monitoring network composition including review of quality, efficiencies, and member satisfaction
    • Reviews network composition and analytics to ensure meeting regulatory requirements, provider accessibility, provider network standards, and network engagement in value-based care goals
    • Collaborates with internal teams to develop analytical reports and monitor network, maintain provider resources including the provider manual and provider directory, update of referral management tools, and ensure data integrity of the network.
    • Collaborates with teams and providers to promote growth initiatives expanding network and membership growth
    CANDIDATE QUALIFICATIONS
    Education
    • High school diploma required;
    • Bachelor’s Required or relative experience in healthcare field
    Licenses/Certifications
    • None
    Experience
    • Two years (2) years of experience working in a health care or regulatory environment preferably including experience working with provider clinics, regulatory agencies, data analysis, and project management
    Responsibilities
    • Understanding of CMS and TDI Network Adequacy Standards and Regulations
    • Responsible for the outreach of potential network providers to meet the network adequacy regulations and expansion of the current network
    • Responsible to collaborate with internal and external stakeholders to meet regulatory reporting deadlines
    • Other duties assigned to assist with the success of the network operations team
    Skills
    • Experience with Microsoft Office and Visio
    • Skilled in the use of Excel for data analysis 
    • Preferred systems knowledge – HRP, Symplr (or similar contract database), Quest Analytics, etc.
    • Preferred provider relations or network operations experience
    • Effective and professional oral and written communication skills
    • Strong interpersonal skills to work with all levels across all functional areas to include internal and external business partners
  • 16 Days Ago

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Revenue Cycle Specialist - Patient Services
  • Provider's Choice Laboratory
  • Houston, TX FULL_TIME
  • Revenue Cycle Specialist - Patient Services Provider's Choice Laboratory is a new generation of laboratory testing and patient care. We provide PCR diagnostic laboratory testing and service providers ...
  • 5 Days Ago

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Provider network representative
  • Integrated Resources, Inc
  • Richardson, TX FULL_TIME
  • Job Title : Provider Network Representative Job Location : Hybrid - Richardson, TX Job Duration : 6 Months (Possibilities of Extension) Job details : This is a training position where the incumbent is...
  • 25 Days Ago

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Provider Network Representative
  • HireOps Staffing, LLC
  • Richardson, TX FULL_TIME
  • This is a contract to hire position. Pay $30/hour This position is 3 days onsite and 2 days remote - Richardson, TX 1. Provide information and assistance needed to resolve problems experienced by prac...
  • 26 Days Ago

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Acclaim Provider
  • JPS Health Network
  • Fort Worth, TX FULL_TIME
  • Acclaim Physician Group, Inc. (Acclaim) is a multi specialty medical group practice comprised of over 500 physicians, nurse practitioners, and physician assistants that partner with JPS Health Network...
  • 1 Month Ago

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Network Specialist
  • Spero LLC
  • Lewisville, TX FULL_TIME
  • Our growing organization is currently seeking an enthusiastic and customer-focused Network Engineer to join our team. This dual-role position will require the successful candidate to provide network s...
  • 2 Days Ago

Texas (/ˈtɛksəs/, locally /ˈtɛksɪz/; Spanish: Texas or Tejas Spanish pronunciation: [ˈtexas] (listen)) is the second largest state in the United States by both area and population. Geographically located in the South Central region of the country, Texas shares borders with the U.S. states of Louisiana to the east, Arkansas to the northeast, Oklahoma to the north, New Mexico to the west, and the Mexican states of Chihuahua, Coahuila, Nuevo León, and Tamaulipas to the southwest, while the Gulf of Mexico is to the southeast. Houston is the most populous city in Texas and the fourth largest in the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$57,818 to $86,465

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