Network Relations I

CorVel Corporation; Waukesha (WI); Sur place; USD 23 000 - 37 000; Plein temps

Résumé du poste

CorVel Corporation in Wisconsin is seeking a Network Relations professional to support provider data integrity and network development. The role emphasizes excellent customer service, strong interpersonal skills, and market knowledge of the medical provider landscape.

You will verify provider documentation, assist with orientation, manage contracts, conduct data audits, and coordinate roster updates across national scope.

Qualifications

• Associate’s degree or two or more years of equivalent work experience.
• Customer service education/training within the insurance industry, managed care or related field.

Responsabilités

• Assist Developer with implementing medical providers, using written and verbal communication.
• Verify all provider signatures, contracts and documentation before submitting for internal processing.
• Review credentials of prospective providers to be considered for acceptance into network per national credentialing requirements and protocols.
• Provide orientation on managed care procedures and establish liaison(s) with all participating providers.
• Assist and communicate with provider orientation program in cooperation with Developer.
• Distribute and maintain provider manual and orientation materials per state guidelines.
• Receive and resolve all disputes involving provider contract and payment issues in accordance with contract Dispute Resolution Procedures.
• Provide assistance and respond to staff requests for information regarding the network, both locally and nationally.
• Oversee distribution of executed contracts and maintenance of database.
• Assist with network marketing, employer and payor relations and product development.
• Conduct and manage provider data audits that ensure data integrity for network and oversee all provider updates and changes with NDB.
• Coordinate and process provider roster updates at least annually or as otherwise required.
• Perform facility site surveys as needed per credentialing requirements or state guidelines.
• Identify specialties within network and generate a recruitment list for Developer.
• Additional duties as assigned.

Connaissances

Interpersonal skills

Written communication

Verbal communication

Complex problem solving

Adaptability

Organizational skills

Attention to detail

Formation

Associate’s degree or two+ years of equivalent work experience

Customer service education/training in insurance/managed care

Outils

Microsoft Office

Description du poste

The Network Relations role supports the frontline of Network Development, responsible for providing excellent customer service while impacting and overseeing provider data integrity. This role must combine strong interpersonal skills with an aptitude in the medical provider market.

Essential Functions & Responsibilities

• Assist Developer with implementing medical providers, using written and verbal communication
• Verify all provider signatures, contracts and documentation before submitting for internal processing
• Review credentials of prospective providers to be considered for acceptance into network per national credentialing requirements and protocols
• Provide orientation on managed care procedures and establish liaison(s) with all participating providers
• Assist and communicate with provider orientation program in cooperation with Developer
• Distribute and maintain provider manual and orientation materials per state guidelines
• Receive and resolve all disputes involving provider contract and payment issues in accordance with contract Dispute Resolution Procedures
• Provide assistance and respond to staff requests for information regarding the network, both locally and nationally
• Oversee distribution of executed contracts and maintenance of database
• Assist with network marketing, employer and payor relations and product development
• Conduct and manage provider data audits that ensure data integrity for network and oversee all provider updates and changes with NDB
• Coordinate and process provider roster updates at least annually or as otherwise required
• Perform facility site surveys as needed per credentialing requirements or state guidelines
• Identify specialties within network and generate a recruitment list for Developer
• Additional duties as assigned

Knowledge & Skills

• Strong interpersonal skills and adaptive communication style
• Complex problem solving skills and innovation
• Ability to quickly adapt to process changes
• Ability to prioritize and manage assignments, scheduled or unscheduled
• Ability to embrace new tools and procedures per corporate guidelines and objectives
• Strong organizational skills
• Excellent written and verbal communication skills
• Superb attention to detail and ability to deliver results in a fast paced and dynamic environment
• Proficient in Microsoft Office applications

Education & Experience

• Associate’s degree or two or more years of equivalent work experience
• Customer service education/training within the insurance industry, managed care or related field

Pay Range

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $16.74 - $26.92 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

About Corvel

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.