Senior Specialist, Provider Network Administration

Provider Network Administration

Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all enrollment and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts. This role is a multi-faceted internal stakeholder facing position.

Knowledge / Skills / Abilities :

• Bridge communication and collaboration between IT, PMO, provider network teams and business end users to align objectives and drive coordination of project delivery activities.
• Serve as a business user partner in IT development, providing requirements, input on solution / UI design, and leading user acceptance testing.
• Lead efforts in identifying and analyzing workflow inefficiencies, recommend process improvements, and collaborate with cross-functional teams to design and implement optimized solutions that enhance operational performance and productivity.
• Deliver customer-focused support and training to ensure smooth project delivery, successful adoption and effective utilization of implemented solutions.
• Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services / Provider Inquiry Research & Resolution, Provider Contracting / Provider Relationship Management).
• Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory / accreditation requirements, and Network Management business operations.
• Generates other provider-related reports, such as : claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.); and mailing label extract generation.
• Develops and maintains documentation and guidelines for all assigned areas of responsibility.

Job Qualifications : Required Education :

Bachelor's Degree or equivalent combination of education and experience

Required Experience :

3-5 years managed care experience, including 2+ years in Provider Claims and / or Provider Network Administration.

3+ years' experience in Medical Terminology, CPT, ICD-9 codes, etc.

Access and Excel intermediate skill level (or higher)

Preferred Education :

Bachelor's Degree

Preferred Experience :

5+ years managed care experience

QNXT; SQL experience

Crystal Reports for data extraction

3+ years' experience in Salesforce User Interface is required.

Experience in User Acceptance Testing is required (UAT).

Pay Range : $77,969 - $106,214 / ANNUAL