CareMore Health · 1 week ago
Network Relations Consultant
Los Angeles, CA
Full-time
Onsite
Mid Level
$81K/yr - $101K/yr
3+ years expCareMore Health is focused on improving healthcare delivery, and they are seeking a Network Relations Consultant to manage provider relationships and performance. This role involves developing positive provider relationships, resolving complex provider issues, and ensuring high-quality service delivery to the provider community.
Health CareMedicalPersonal HealthService Industry
Responsibilities
Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues
Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution
May be responsible for coordinating non-negotiated contracts for new and existing providers as needed
Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices
May participation in Joint Operation Committees (JOC) of larger provider groups
Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns
Conducts seminars to support the understanding of managed care policies and procedures
Identifies network access and deficiencies and develops recruitment and contracting strategies
Coordinates and conducts provider training including developing and distributing provider relations materials
Responsible for providing quality, accessible and comprehensive service to the company's provider community
Provide assistance regarding education, contract questions and non-routine claim issues
Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns
Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department
Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery
Tracks and conduct provider refresher training
Researches issues that may impact future provider negotiations or jeopardize network retention
Qualification
Required
Requires a Bachelor's degree
Minimum of 3 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background
Travels to worksite and other locations as necessary
Benefits
This position is bonus eligible based on individual and company performance.
Company
CareMore Health
CareMore Health provides healthcare delivery system.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Paul Mikulecky, MD, MBA, CPE
VP & Chief Medical Officer
Lauren F Burns
Clinical Education Partner
Recent News
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