Provider Network Consultant

VIVA USA Inc; Austin (TX); Hybrid; USD 52,000 - 76,000; Full time

Benefits offered by this job

Remote work

Job summary

VIVA USA Inc. seeks a health insurance provider services professional in Austin, TX.

This remote-capable role supports Medicare and Medicaid provider operations while allowing flexible location within Austin. You will research and resolve provider inquiries arising from contract operations, system data entry, claims, and directory issues, and coordinate with Provider Network, Provider Relations, and Government Programs staff.

Qualifications

• Bachelor degree OR 2 years experience in health insurance/managed care.
• Strong written and verbal communication to educate providers and resolve issues.
• Proficient with Microsoft Word and Excel.
• HS Diploma/GED.
• Bachelor Degree with one year business experience.
• Knowledge of health care industry, contracts, products, claims processing.
• Knowledge of government health care products.
• Strong TX Medicare claims and provider relations knowledge.

Responsibilities

• Support Medicare and Medicaid provider services and provider operations.
• Research and resolve provider inquiries from contract operations, system, data entry claims payment, and directory issues.
• External communications educating and updating the Medicaid and Medicare provider network community regarding client policy updates, system and contractual changes.
• Assist in the composition and coordination of revised policies and procedures.

Skills

Provider relations knowledge

Medicare/Medicaid knowledge

Written & verbal communication

PC proficiency

Education

Bachelor degree or 2 years health insurance/managed care experience

Tools

Microsoft Word

Microsoft Excel

Job description

Remote-candidates must be in Austin TX.

This position is responsible for supporting Medicare and Medicaid provider services, provider operations of individual Medicare and Medicaid providers. This position is accountable for researching and resolving provider inquiries arising from contract operations, system, data entry claims payment, and directory issues. This position is responsible for internal communications including working with Provider Network, Provider Relations, and Government Programs staff on issue resolution, This position is responsible for external communications including educating and updating the l Medicaid and Medicare provider network community regarding client policy updates, system and contractual changes. Assist in the composition and coordination of revised policies and procedures.

JOB REQUIREMENTS

• Bachelor degree OR 2 year of experience in health insurance/managed care industry handling independent decision making.
• Written and verbal communication skills to compose responses to external and internal entities, to educate providers, to compose training materials and procedures, to work across departments to resolve provider issues including claim research.
• PC proficiency including Microsoft Word and Excel.
• HS Diploma/GED

PREFERRED JOB REQUIREMENTS

• Bachelor Degree with one year business experience.
• Knowledge of health care industry, contracts, products, claims processing.
• Knowledge of government health care products.

Required Qualification(s)

• Strong TX Medicare claims and provider relations knowledge

Notes

• Remote
• This is a contract role with the possibility of conversion to full-time based on business needs and performance

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status