Network Service Consultant

🕒 Agosto 14

⚔️ Virginia, West Virginia – Remoto

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

💼 Consultor

👻 Score fantasma 45%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Peak Health

SiteLinkedInTodas as Vagas

51 - 200 funcionários

🏥 Saúde

💼 Consultoria

🛡️ Seguros

Healthcare • Consulting • Insurance

A Peak Health é uma seguradora de saúde e serviços de seguros de saúde com sede em Morgantown, West Virginia. É de propriedade de três prestadores de saúde sem fins lucrativos: WVU Health System, Marshall Health Network e Valley Health. A Peak Health tem como objetivo melhorar os resultados de saúde da comunidade oferecendo um plano de saúde inclusivo, liderado por fornecedores para os residentes da Virgínia Ocidental e áreas adjacentes. A empresa está comprometida em tornar os cuidados de saúde mais acessíveis, compreensíveis e colaborativos, com foco na redução de custos e taxas administrativas para pacientes e empregadores. A Peak Health também oferece cobertura do Medicare Advantage, adaptada para idosos da Virgínia Ocidental, por meio de parcerias com os principais sistemas de saúde.

Descrição

• Develop and maintain collaborative relationships with providers, including physicians, hospitals, ancillary providers, and vendors • Shape the provider network landscape through objective data and education across stakeholders and product lines • Educate providers on credentialing, contracting, authorizations, referrals, claims and encounters, grievances and appeals, health education, population health, care management, pharmacy management, electronic health records, health information exchange, data exchange, and regulatory updates • Conduct provider outreach through email, telephone, in-person meetings, and webinars • Assess provider efficiencies when interacting with the health plan • Conduct initial provider orientations and ongoing educational outreach • Conduct group training sessions • Assist with provider contract questions, research problems, and resolve escalated issues • Represent the health plan at healthcare association functions • Participate in regulatory reporting for provider networks • Monitor competitors and market regulations • Support strategic positioning to develop and maintain provider networks • Assist the Credentialing Department with difficult-to-obtain documents • Collaborate with Claims Operations, Medical Management, Credentialing, Contracting, Legal, Analytics, Compliance, Sales and Marketing, and Member and Provider Service teams • Report to the Manager Network Services as a member of the Provider Relations team

🎯 Requisitos

• Bachelor’s Degree in business or a healthcare-related field • Basic understanding of contracts, Value Based Reimbursement, performance-based provider reimbursement programs, and Commercial, Medicare Advantage, Medicaid, and PEIA products • Understanding of regulatory reporting for provider networks, including the WV Department of Insurance, Department of Medicaid/Health Services, and CMS • Understanding of provider quality measurement systems such as Medicare STARS, HEDIS, and PCMH quality programs • Strategic thinking and attention to detail • Knowledge of federal and state laws, including CMS and BMS • Excellent written and oral communication • Demonstrated ability to build and retain relationships • Proficiency with Microsoft Office • Experience with Commercial, Medicare, and Medicaid products • Understanding of provider credentialing and data management processes • Working knowledge of claims and/or coding • Established provider relationships in West Virginia • Standard office-environment work conditions • Ability to travel to offsite meetings when required

🏖️ Benefícios

• Full-time employment • 40 scheduled hours per week • Some travel may be required to offsite meetings • Reasonable accommodations may be made for individuals with disabilities

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