Network Data Coordinator - Network Business Development - Southwestern Health Resources (SWHR)
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EducationBachelor's Degree Related Field Req Or
H.S. Diploma or Equivalent 4 Years Experience in Healthcare, Healthplan, or Provider Environment lieu of Bachelors Degree ReqExperience3 Years Experience in a similar position in a health plan or network setting provider contract implementation or enrollment experience with Commercial, Medicare and/or Medicaid experience to include 1 year Experience in a client-facing account management role in a Medicare or healthcare payor role (with Bachelor's Degree.) Req or
7 Years Experience in a similar position in a health plan or network setting provider contract implementation or enrollment experience with Commercial, Medicare and/or Medicaid experience to include 1 year Experience in a client-facing account management role in a Medicare or healthcare payor role (without Bachelor's Degree) Req
2 Years Population Health Experience PrefSkills Knowledge of billing, coding, and payor reimbursement methods within health care.
Travel-Must be able to travel locally to SWHR Physician Network Providers.
Proficient in MS Excel and/or MS Access.
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.
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.
Work requires strong knowledge in EPIC, Cactus, MS Office Suite, Salesforce, VISIO.SupervisionThis position manages peopleADA RequirementsWorking Indoors 67% or morePhysical DemandsSedentaryTravel RequirementsLocal 10% Local to Network Provider Clinics
H.S. Diploma or Equivalent 4 Years Experience in Healthcare, Healthplan, or Provider Environment lieu of Bachelors Degree ReqExperience3 Years Experience in a similar position in a health plan or network setting provider contract implementation or enrollment experience with Commercial, Medicare and/or Medicaid experience to include 1 year Experience in a client-facing account management role in a Medicare or healthcare payor role (with Bachelor's Degree.) Req or
7 Years Experience in a similar position in a health plan or network setting provider contract implementation or enrollment experience with Commercial, Medicare and/or Medicaid experience to include 1 year Experience in a client-facing account management role in a Medicare or healthcare payor role (without Bachelor's Degree) Req
2 Years Population Health Experience PrefSkills Knowledge of billing, coding, and payor reimbursement methods within health care.
Travel-Must be able to travel locally to SWHR Physician Network Providers.
Proficient in MS Excel and/or MS Access.
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.
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.
Work requires strong knowledge in EPIC, Cactus, MS Office Suite, Salesforce, VISIO.SupervisionThis position manages peopleADA RequirementsWorking Indoors 67% or morePhysical DemandsSedentaryTravel RequirementsLocal 10% Local to Network Provider Clinics