Job Description
Provider Network Specialist-Physical Health Enrollment/Maint
Join to apply for the Provider Network Specialist-Physical Health Enrollment/Maint role at Partners Health Management
Provider Network Specialist-Physical Health Enrollment/Maint
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Join to apply for the Provider Network Specialist-Physical Health Enrollment/Maint role at Partners Health Management
Competitive Compensation & Benefits Package! Position eligible for
- Annual incentive bonus plan
- Medical, dental, and vision insurance with low deductible/low cost health plan
- Generous vacation and sick time accrual
- 12 paid holidays
- State Retirement (pension plan)
- 401(k) Plan with employer match
- Company paid life and disability insurance
- Wellness Programs
- Public Service Loan Forgiveness Qualifying Employer
See attachment for additional details.
Location: Remote option; Available for any of Partners NC locations
Projected Hiring Range : Depending on Experience
Closing Date :
Open Until Filled Primary Purpose of Position: This position assists in the enrollment, maintenance, development and management of the Provider Network for consumers who have been identified as having mental health, substance use or intellectual development disability needs.
Role And Responsibilities - Provide support to internal and external stakeholders to resolve provider data issues
- Research and effectively respond to provider data related issues
- Track, update and audit provider data
- Research and identify any processing inaccuracies in provider data ingestion and work with internal and external stakeholders to resolve the issues
- Work with other departments on cross functional tasks and projects
- Completes special projects as assigned
- Collaborate with health plan regarding compliance with provider set up and validation for all network requirements through data review, monitoring and collaboration.
- Attention to detail and adherence to strict timelines is essential to the success of this position;
- Must be able to work independently and use good judgement in making critical decisions that impact service availability inside the Partners network;
- Manage and foster solid collaborative relationships with external stakeholders and internal department leaders to develop the innovation and recommendations for next steps.
- Assess and manage risk throughout all aspects of the solution design and development and escalates as needed.
- Monitor progress, reports results/outcomes and adjusts as needed.
- Interpret audit results, identifies trends/patterns that impact service/system quality, and then implements interventions aimed at addressing these trends/patterns with the outcome of services delivery to consumers at the highest degree of quality cross functional team activities;
- Provide appropriate reports and statistical data to other department designees for review, follow-up and resolution
- Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements
- Evaluate risks and concerns and communicate to management
- Serve as the subject matter expert on provider set up and validation to ensure operational performance
- Resolve issues and identify opportunities for process redesign and improvement
Knowledge, Skills And Abilities - Considerable knowledge of the laws, regulations and policies that govern the program
- Exceptional interpersonal, communication, and writing skills
- Strong problem solving, negotiation, arbitration, and conflict resolution skills
- Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint)
- Ability to make prompt independent decisions based upon relevant facts
- Ability to establish rapport and maintain effective working relationships
- Ability to act with tact and diplomacy in all situations
- Ability to maintain strict confidentiality in all areas of work
- Ability to prioritize work to meet deadlines
- Ability to present complex data and information to varying audiences, both internal and external, in a professional and clear manner
- Ability to apply appropriate judgment and discretion in interpreting and reporting of data
- Ability to summarize analytical results graphically and numerically in Microsoft Excel, PowerPoint, and ability to utilize various software products
- Ability to summarize analytical results graphically and numerically
Education/Experience Required: Bachelors Degree in mental health, public health, social work, psychology, education, sociology, business or public administration and five (5) years of experience in a community, business, or governmental program in health-related fields, social work or education including experience in network operations, provider relations and management experience.
A combination of relevant experience may be considered in lieu of a bachelors degree.
Must have ability to travel as needed to perform job duties.
NC Residency is required.
Education/Experience Preferred: Masters Degree in mental health, public health, social work, psychology, education, sociology, business or public administration and two (2) years of experience in a community, business, or governmental program in health-related fields, social work or education including experience in network operations, provider relations and management experience.
Licensure/Certification Requirements: N/A
Seniority level
Seniority level
Mid-Senior level
Employment type
Employment type
Full-time
Job function
Job function
Information Technology -
Industries
Hospitals and Health Care
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Job Tags
Full time, Contract work, Work at office, Remote work,