Senior Analyst, Network Relations
Description:
- The Medicaid Network Provider Relations Manager oversees our Medicaid Provider Experience programs
- Acts as the primary contact for an assigned profile of larger and more complex providers
- Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, network growth and efficiency targets
- Research and handle contract related issues
- Claims research related to provider set up issues, payment resolutions
- Facilitate JOCs and webinars, provider orientations/visits, provider training, state projects
- Create and manage provider-facing communications
- Collaborate with Quality Management and VBS team
- Coordinate with Network Management to issue provider CAP
- Monitor Grievances according NCQA standards categories
- Document visits/encounters in the appropriate systems
Requirements:
- Excellent interpersonal skills and the ability to work with others at all levels
- Minimum of 2 years’ experience with Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
- Excellent analytical and problem-solving skills
- Strong communication and presentation skills
- 3+ years' experience in Medicaid Managed Care business segment environment with exposure to benefits and/or contract interpretation
- Working knowledge of business segment specific codes, products, and terminology
Benefits:
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings
- Tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
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