Healthcare Provider Relations Network Specialist

Education
Bachelor's Degree in Related Field Required

Experience
3 years’ experience in a Client-Facing Account Management role in the Healthcare Industry / Payor Relations (Commercial, Medicare, Medicaid) with exposure to ACO, Claims, or Payor Contracts Required
Knowledge of Billing, Coding, and Payor Reimbursement Methods within Healthcare Required

Travel Requirements
Occasional travel locally to SWHR Physician Network Providers

Skills
Proficient in MS PowerPoint and ability to present to large and small crowds
Project management skills, and strong planning and organizational skills.
Project delivery methodology skills
Exceptional facilitation skills and communicating strategies and adjusting strategies based on the feedback of stakeholders.
Highly detailed oriented with the ability to troubleshoot issues/SWHR Physician Network or Payor requests quickly and provide organizational guidance.
Ability to hold organization as well as SWHR Physician Network or Payor accountable to deliver on operational requirements.
Strong data, analytics, and quantitative acumen
Familiarity with processes of CPT, HCPCS, ICD-9, coverage and reimbursement.
Familiarity with health insurance claim forms, including CMS-1500, explanation of benefits, and prior authorization forms, and superbills charge tickets to troubleshoot cases where billing, claims submission or documentation errors may occur
Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
Strong project management approach with excellent critical thinking and problem-solving skills
Work requires strong knowledge in EPIC, Cactus, MS Office Suite, Salesforce, VISIO

Supervision
Individual Contributor

ADA Requirements
Working Indoors 67% or more

Physical Demands
Sedentary