Network Relations Coordinator (Non-Exempt Remote/Hybrid/On-site)

Quality Care Partners, llc.; Ohio; On-site; USD 48,000 - 62,000; Full time

Job summary

Quality Care Partners seeks a provider relations and pricing specialist to maintain network relationships and assist in pricing and policy interpretation. The role supports claims processing, pricing adjustments, and serves as liaison between payors and providers with focus on accurate coding and compliant documentation.

You will be involved in network participation decisions, negotiate with non-contracted providers, and assist staff on provider issues while upholding QCP values and

Qualifications

• High school degree or equivalent required.
• Bachelor of Science in communications, marketing or healthcare related field preferred or equivalent experience.
• 2 years experience in healthcare billing, coding, insurance follow up or related provider claim processes.
• Certified Coder preferred.

Responsibilities

• Answer and resolve calls related to claims status and network status.
• Re-price claims.
• Determine network participation for claims purposes.
• Act as liaison between payors and providers.
• Research and resolve Claimsbridge denials and related claims issues.
• Negotiate with non-contracted providers and complete documentation for billing savings.
• Outreach to non-contracted providers and follow-up.
• Other duties as assigned.

Skills

Billing follow-up

Provider relations

Data analysis

Communication skills

Education

BS in healthcare/communications/marketing

Tools

Microsoft Office

Excel

Job description

Responsible for maintaining working relationships within the existing network. Assist in the recruitment of new providers. Responsible for pricing and issues with pricing. Assist with policy and procedure interpretation.

RESPONSIBILITIES

• Answer, direct and resolve phone calls related to:
  • -Claims Status from Repricing
  • -Network Status
  • -Occasional main phone line backup
• Re-price claims.
• Determines network participation for claims purposes (e.g. Claimsbridge, TPA)
• Act as liaison between payors and providers.
• Act as resource to QCP staff related to provider issues that arise.
• Research and resolve Claimsbridge denials and any associated claims issues.
• Negotiate with non-contracted providers and complete associated documentation to allow for billing % of savings.
• Non-contracted providers(s) review, reach out, follow-up, etc.
• OPPOC non-contracted provider(s), research, reach out and inquiries
• QCP non-contracted provider(s) reach out and inquiries
• Other duties as assigned.

REQUIRED QUALIFICATIONS

High school degree or equivalent required. Bachelor of Science in communications, marketing or healthcare related field preferred or equivalent experience. Previous 2 years experience in healthcare billing, coding, insurance follow up or other medical office experience relevant to provider claim processes and follow up. Certified Coder preferred.

DEMONSTRATE QCP VALUES

The values of Quality Care Partners are demonstrated on a daily basis and reflected through job duties and responsibilities as evidenced by:

• Caring: Seek to listen, understand and respond to our customers’ needs with care; Communicate with co-workers and customers with positivity and empathy; Be good stewards of QCP resources.
• Excellence: Strive to exceed, not just meet expectations; Always deliver services with accuracy and efficiency; Recognize and utilize your strengths and the strengths of others.
• Improvement: Bring new ideas to create positive change and solutions; Be open to the ideas and suggestions of others; Be an advocate to continuously improve QCP.
• Accountability: Take ownership for your daily decisions; Stay focused on your job and eliminate distractions while at work; Demonstrate QCP values in everything you do.

TRAITS AND APTITUDES

• High level of awareness of pertinent details; excellent organizational skills
• Strong analytic and problem-solving abilities
• Effective and efficient oral and written communication skills.
• Knowledge of ICD-9/10 and CPT codes required
• Must handle pressure effectively
• Professional appearance and demeanor
• Able to maintain confidentiality
• Ability to use PC software (Microsoft Office-Excel, Word, PowerPoint) with the ability to master programs needed for position

PHYSICAL DEMANDS AND WORK CONDITIONS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must have excellent written and verbal communication skills as well as the ability to observe, assess, guide and evaluate others.
• Must be able to hear, speak, and see and to coordinate motor skills.
• Must be able to climb, lift 25 pounds, stoop and bend and reach above head.
• Ability to collect data, interpret findings, set priorities and carry out established plan.
• Ability to read, write and utilize manual and computerized systems of documentation.
• Must read a significant amount of information in a relatively short period of time.

EEO STATEMENT

Quality Care Partners is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics.

REPORTING RELATIONSHIPS

Position Reports to: Director of Network Development