POSITION OVERVIEW

The Provider Network Specialist is responsible for managing complex provider inquiries by providing accurate information to necessary stakeholders and delivering high quality service through regular engagement, performing duties in a timely manner, and representing the organization in a manner aligning with Zing Heath’s mission.
The Provider Network Specialist will be responsible for building and nurturing positive relationships with providers and providing support to the Network Management Team.

EDUCATION/EXPERIENCE

• A minimum of three (3) years of provider relations and data management experience, preferably in managed care.
• Knowledge of Managed Care Medicare, or Medicaid.
• Previous experience working with data management in large databases, reporting and analysis.
• Understanding of health insurance claims, as well as an ability to analyze data to resolve provider issues.
• Knowledge and understanding of the health care industry, including basic medical claim processing, ICD-10 Diagnosis Codes, CPT Procedures Coding, HCPC Codes, HCFA 1500, and UB-92 claim forms.
• Excellent customer service skills.
• Must have the ability to work independently and within a team environment.
• Ability to multi-task.
• Must have excellent decision-making and problem–solving skills.
• Must be well organized and detail oriented.
• Proficient in Microsoft Office applications, preferably advanced in Excel.

• Handle provider inquiries timely and effectively; documenting discussions, issues, and action items.
• Research claim issues and route to the appropriate staff for resolution.
• Perform day to day duties of assuring that providers (hospital systems, group, ancillary, etc.) are set up accurately in the provider information system for reporting, claims payment, and directories (Data Management).
• Submit provider data entries to resolve provider-related demographic information changes.
• Prepare monthly and quarterly reports of network providers as requested.
• Conduct internal audits of contract inventory, provider files and others, as well as routine network directory audits.
• Tracking, filing and distribution of contracts, as well as general administrative support of department
• Collaborate with other departments, vendors, and providers to improve or maintain processes, systems, contracts, and relationships.
• Assist in strategic projects to help improve efficiencies.
  Requirements: