- Manages individual and group provider relationships with insurance to include standard contracting, onboarding, claims training, and resolution of providers' issues, including claims payment, quality and performance initiatives, improved access, and controlling unnecessary costs.
- Ensures that contract and regulatory network adequacy requirements are met by continuously developing new provider relationships while strengthening existing relationships.
- Supports the implementation of business changes to simplify operations and improve all provider business experiences with insurance companies.
- Off-site visits will help resolve service issues, gather market intelligence and contract-related concerns, and provide education to ensure and strengthen relations with providers.
- Must have a valid driver's license, access to an automobile with a current license and registration
- Experience in Healthcare for 1 years.
- Responsible for initiating and providing face-to-face support to new providers interested in joining the insurance network.
- Develops the content and coordinates with educators and SMEs as appropriate to maintain and implement operational content used to train both Provider Servicing staff and Providers' business offices.
- Supports development and implementation of policy changes on behalf of Provider Services and communicates the provider perspective when representing the department on cross-functional teams, corporate initiatives, and tactical objectives.
- Work with others to identify and fill network gaps and propose strategies to fill gaps.
- Coordinates case resolution with internal business areas to respond (in writing, telephonic, or face-to-face) timely and accurately to provider inquiries regarding claims, benefits, and complex issues, including medical or payment policy questions and provider appeals.
- Proactively resolve problems to ensure compliance with contract terms and resolve problems due to system programming to build trust and strong business relations with all providers.
- Healthcare billing and coding experience is a plus
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Healthcare Specialist - Honolulu, United States - TEKsystems
Description
TEKsystems in Hawaii is looking for a Healthcare Specialist to support one of the local healthcare companies in Hawaii This role is primarily remote but requires some occasional travel 1-2 times a week on Oahu or Kauai.
Travel expenses will be paid for. If you are interested, please apply for the position, and one of our associates will call or email you.Description:
Qualifications:
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity.
We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia.
As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change.
That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
