Senior Provider Engagement Network Specialist

Position Purpose: Perform day to day duties of assuring that providers are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up. Provide support to external provider representatives to resolve provider data issues. Research and effectively respond to provider related issues. Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT. Act as the internal and external liaison for provider networking, maintaining positive working relationships with participating physicians, participating physician groups (PPG’s), multi-specialty groups, and/or ancillary providers within assigned area. Act as account manager for assigned groups acting as gatekeeper for interactions with other internal departments. Responsible for daily administration and operation of the contractual provider relationships, including overseeing accurate and current provider databases, providing training, education and information to providers. Research, analyze and resolve complex problems dealing with contract loading, division of financial responsibility interpretation, contract rate and