Provider Network Specialist jobs in the United States

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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Contract Configuration Specialist
  • HERITAGE PROVIDER NETWORK
  • Northridge, CA FULL_TIME
  • Position Summary:

     

    Provides support in the ongoing maintenance and configuration of Regal Medical Group systems, including but not limited to the data entry of Contracting Database, Providers, Vendors, Fee schedules, Capitation Configuration.  Performs system maintenance functions in a manner that is responsive to customer needs and support Regal initiatives.

     

    Essential Duties and Responsibilities include the following::

    • Adheres to Data integrity policies for all system configurations.
    • Responsible for the accurate and timely completion of tasks assigned.
    • Performs random audits as required to support policies and procedures for data integrity.
    • Communicates with management and makes recommendations to improve processes.
    • Ensure all systems within their area of responsibility are reliable, responsive and support to the needs of the Medical Group networks.
    • Maintains a customer satisfaction focused, service mentality to strengthen and build relationships with Heritage Provider Network and all Medical Groups under HPN.
    • Attends administrative meetings as requested.
    • Process a minimum of 60 provider adds daily.
    • Performs other duties as necessary.

     

    PRIMARY DAILY FUNCTION

     

    MORNING

    • Generate (PCF) Provider Can’t Find report at 8:10 AM sorting by highest lag days.
      • High lag Days -Send excel file via email to claims managers and cc: data management directors and managers listing high lag day claims.
        • Analyst must turnaround before the afternoon reports are generated.
      • Outstanding PCF’s - Send excel file via email to data management directors and managers with one worksheet listing outstanding PCF claims and second. worksheet pivoting a summarized list of claims by Date Received.
    • Generate DM Notes.xls by 8:10 AM
      • Archive worksheet - Send excel file via email to claims managers and CC: data management directors and managers.
      • Rejected worksheet - Send excel file via email to claims managers and CC: data management directors and managers.

     

    Emails must go out by 8:15 AM

     

     AFTERNOON

    • Generate a batch file of high lag day PCF’s and run the file through Symkey between 12:00 – 12:30 pm.
    • Generate a batch file of PCF’s that were able to be mapped in the morning and run the file through Symkey between 12-12:30 pm.
    • Generate a batch file claims that need a DM Notes and run the file through Symkey between 12:00 – 12:30 pm.
    • Generate PCF report after running morning Symkey batch files sorting by highest lag days by 1:15 pm.
      • High lag Days -Send excel file via email to claims managers and cc: data management directors and managers listing high lag day claims.
        • Analyst must turnaround before the afternoon reports are generated.
      • Outstanding PCF’s - Send excel file via email to data management directors and managers with one worksheet listing outstanding PCF claims and second worksheet pivoting a summarized list of claims by Date Received.

     

    Emails must go out by 1:20 PM

     

    EVENING

    • Generate a batch file of high lag day PCF’s and run the file through Symkey.
    • Generate a batch file of PCF’s that were able to be mapped in the morning and run the file through Symkey.

     

    Start Symkey jobs by 4:30 PM

     

    • All other duties as directed by management.

     

    The pay range for this position at commencement of employment is expected to be between  $20 - $25 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

     

    The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

     

    Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

     

    If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

     

    As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

     

    Full Time Position Benefits:

     

    The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

     

    Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

     

    Health and Wellness:

    • Employer-paid comprehensive medical, pharmacy, and dental for employees
    • Vision insurance
    • Zero co-payments for employed physician office visits
    • Flexible Spending Account (FSA)
    • Employer-Paid Life Insurance
    • Employee Assistance Program (EAP)
    • Behavioral Health Services

    Savings and Retirement:

    • 401k Retirement Savings Plan
    • Income Protection Insurance

    Other Benefits:

    • Vacation Time
    • Company celebrations
    • Employee Assistance Program
    • Employee Referral Bonus
    • Tuition Reimbursement
    • License Renewal CEU Cost Reimbursement Program
    • Business-casual working environment
    • Sick days
    • Paid holidays
    • Mileage

    Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

  • 1 Day Ago

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Network Engineer
  • HERITAGE PROVIDER NETWORK
  • Northridge, CA FULL_TIME
  • Position Summary: The Network Engineer will be a proactive customer-focused advocate and a strategist with meaningful experience across multiple technology areas. They will provide enterprise level ne...
  • 9 Days Ago

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Provider Network Development Specialist
  • CINQCARE
  • New York, NY FULL_TIME
  • CINQCARENYS Provider Network Development Specialist Position Description OverviewThe Provider Network Development Specialist reports to the Director of Network Management with accountability for provi...
  • 25 Days Ago

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Provider Network Specialist
  • CCHN
  • Remote, NC FULL_TIME
  • Provider Network Specialist Location: Raleigh-Durham, Wilmington or Charlotte, NC / Homebased position Position Purpose: Reporting to the Director, Provider Network, the Provider Network Specialist is...
  • 1 Day Ago

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PROVIDER NETWORK SPECIALIST
  • 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 c...
  • 3 Days Ago

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Provider Network Specialist
  • Lowe's
  • UNKNOWN, NC FULL_TIME
  • Lowe’s is able to offer remote employment of this position in the following states: AL, AR, AZ, CA(salaried roles only), CT, CO, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, MA, ME, MI, MN, MO, MS, MT,...
  • 4 Days Ago

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Network Engineer
  • JCS Solutions LLC
  • Arlington, VA
  • JCS Solutions LLC has a need for a Network Engineer to join our growing team supporting the Defense Information Systems ...
  • 3/28/2024 12:00:00 AM

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Network Engineer
  • Themesoft Inc.
  • Washington, DC
  • Job Title: Network Engineer Location: Washington DC Client : - LTI Mindtree Duration: Long Term Must Have: 10-15 years o...
  • 3/28/2024 12:00:00 AM

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Network Engineer
  • Softworld, a Kelly Company
  • Rockville, MD
  • Softworld Is searching for an experienced Network Engineer to join our client's team onsite in Rockville, MD. 12 month c...
  • 3/27/2024 12:00:00 AM

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Network Engineer
  • Virginia Hospital Center
  • Arlington, VA
  • Network Engineer Job Description Purpose & Scope: The Network Engineer will be responsible for providing network experti...
  • 3/27/2024 12:00:00 AM

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Network Engineer
  • Echelon Services, LLC
  • Chantilly, VA
  • RESPONSIBILITIES: The job duties of the Network Engineer are as follows: Interpret customer requirements and apply stand...
  • 3/26/2024 12:00:00 AM

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Network Engineer
  • Robert Half
  • Washington, DC
  • Job Title: Network Engineer Location: Washington, DC Pay: $40-$60 an hour based on experience Schedule: Hybrid 3 days on...
  • 3/26/2024 12:00:00 AM

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Network Engineer
  • LTI - Larsen & Toubro Infotech
  • Washington, DC
  • About Us: LTIMindtree is a global technology consulting and digital solutions company that enables enterprises across in...
  • 3/26/2024 12:00:00 AM

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Network Engineer
  • Sparks Group
  • Chantilly, VA
  • Position Description: Sparks Group is partnering with an organization in the Tech Ed industry that is looking for a hybr...
  • 3/24/2024 12:00:00 AM

Income Estimation for Provider Network Specialist jobs
$58,818 to $87,961