Provider Network Relations & Pricing Coordinator

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

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