Network Provider Relations & Provider Data Specialist

1 hour, 18 minutes ago
Full-time
Senior
Data Science and Analytics
Evry Health

Evry Health

Evry Health is a modern health insurance company that prioritizes delivering great benefits at affordable prices. They offer a unique approach to health insurance by focusing on making members healthier and happier through personalized care from a dedi...

Insurance
11-50
Founded 2017
$7M raised

Description

  • Manage a geographic medical provider network for the health plan.
  • Review and amend contracts with physicians, physician groups, facilities, and ancillary medical providers.
  • Develop an adequate provider network in assigned geographic areas, currently Texas metroplex markets.
  • Communicate with providers regarding claims issues, service issues, and network complaints.
  • Collect roster updates and standardize provider information with Analytics and IT teams.
  • Coordinate effective dates with the credentialing CVO and maintain network records.
  • Monitor network adequacy, quality, and regulatory time, distance, and choice requirements.
  • Build and maintain relationships with contracted providers and respond to questions about contract status and roster corrections.
  • Run reports, track compliance requirements, identify gaps, and report status, risks, and opportunities to leadership.
  • Work with analytics and actuarial teams to compile and analyze fee schedules and support medical economics reporting.

Requirements

  • 5+ years of experience negotiating provider contracts, including physician and provider group contracts.
  • Experience negotiating commercial contracts with hospital systems and provider groups.
  • Experience with multiple payment methodologies such as percent of Medicare, RBRVS, ICD or similar code sets, case rates, and DRG.
  • Experience with value-based or risk-based contract parameters is preferred.
  • Experience in the Texas provider community and existing provider relationships is desired.
  • Analytical skills, including experience with SERFF reporting of network adequacy.
  • Experience using Salesforce or a similar contract or contact management system.
  • Strong Microsoft Excel skills and ability to handle large data files.
  • Experience reconciling provider roster data and validating provider directory accuracy.
  • Must live in the United States and reside in the US Central or US Eastern time zones.
  • Must have a dedicated private work area and secure handling of sensitive documents.
  • High-speed internet service is required.
  • Experience working in a virtual environment and strong verbal and written communication skills.

Benefits

  • Competitive salary.
  • Full benefits package including health insurance.
  • Dental, vision, life, and disability insurance.
  • 401(k) retirement savings plan with company match.
  • Vacation time.
  • Professional development opportunities.
  • Flexible work environment.
  • Remote work arrangement.

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

Utilization Review Nurse

Oscar 1K-5K Insurance

Oscar Health is hiring a remote Utilization Review Nurse to perform case reviews and determine the appropriateness of requested care for members based on clinical guidelines and medical records.

4 minutes ago

Senior Lifecycle Specialist, Contract Management

Remote 251-1K Professional Services

Remote is hiring a Lifecycle Senior Specialist (OHS) to support its global Employee Lifecycle Operations team by managing occupational health and safety activities across multiple countries.

4 minutes ago

Accounting & Procurement Specialist

Zipdev 51-250 Professional Services

Zipdev is hiring a remote Accounting & Procurement Specialist to manage a client’s bookkeeping, quote desk, and procurement operations while coordinating with internal teams during Pacific Time business hours.

4 minutes ago

Credentialing Specialist

IVX Health 51-250 Health Care Providers & Services

IVX Health is hiring a Credentialing Specialist to manage provider credentialing, enrollment, and payer compliance across its multi-state infusion and injection therapy operations.

4 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers