Provider Network Specialist

Icon Fitness; Battle Creek (MI); Hybrid; USD 45,000 - 75,000; Full time

Job summary

An established industry player is seeking a dedicated Provider Network Specialist to coordinate projects and manage relationships with external Medicaid providers. This role is essential for ensuring compliance and alignment with customer needs while maintaining high standards of service. The position offers a hybrid work setting, allowing flexibility for remote work as needed. Join a passionate team committed to making a difference in the community, with opportunities for professional growth and a supportive work environment. If you have a strong background in project management and a passion for service delivery, this opportunity is perfect for you.

Benefits

Premium health, dental and vision benefits

Short term and long term disability

401(k) match after one year

Free YMCA membership

Generous paid time off

Ten paid holidays

Employee appreciation events

Continuing education reimbursement

Qualifications

• Minimum of three years in a project management role required.
• Strong organizational and communication skills essential.
• Experience with Medicaid billing preferred.

Responsibilities

• Coordinate and manage projects for Provider Network and external providers.
• Handle credentialing and contracting of Medicaid providers.
• Provide exceptional customer service to external providers.

Skills

Project Management

Organizational Skills

Communication Skills

Problem-Solving Skills

Digital Literacy

Technical Aptitude

Critical Thinking

Education

Bachelor's Degree

Extensive Medicaid Experience

Tools

Electronic Medical Record Software

Spreadsheet Software

Web Design/Content Management Tools

Job description

Provider Network Management in 175 College St, Battle Creek, MI 49037-3432, United States Full Time

Reports To: Director of Provider Network

Status: Full-Time

Openings: One

Job Summary/Objective:

Coordinates and manages projects for Provider Network, contracts, communications, and data tracking. Provides data tracking for reporting, strategic implementation of business process, and assist with business and team goals. Serves as an important contact to Summit Pointe’s external providers of Medicaid services and contractors to ensure alignment with meeting customer needs, contractual obligations (Compliance, Process Improvements, Home and Community Based Services), and necessary functions of both Summit Pointe and the external provider. Handles credentialing, re-credentialing and contracting of all external Medicaid providers. Manages fee schedules, annually required provider paperwork, contract execution and document control. Acts as an auditor for all site review activities which includes coordination, auditing and provider remediation.

Essential Duties and Functions:

• Maintains a contracting process for Summit Pointe’s Provider Network. Contracting process includes contract development, tracking, fee schedule maintenance, primary owner for contract drafts and final copies, uploading contracts into software for execution and maintaining version control.
• Facilitates and coordinates audits, provider remediation, trainings and stakeholder meetings.
• Manages all credentialing and recredentialing activities for all external Medicaid providers, ensuring that the process meets all contractual expectations.
• Acts as a liaison with the Human Resources department for all internal credentialing activities that need to be reported to Southwest Michigan Behavioral Health.
• Compiles, monitors, and prepares reports as requested, providing information and support to various work groups and stakeholders.
• Assists with special contract projects as required.
• Provides exceptional customer service to all external providers and community stakeholders.
• Participates in corporate quality improvement and problem-solving activities.
• Maintains confidentiality and privacy with MDHHS, state and federal guidelines.
• Utilizes knowledge of CARF, CMS, MDHHS and Managed Care Standards.
• Performs other duties as required.
• The Provider Network Specialist position is approved for a hybrid work setting, with remote work approved on an individual basis. Employee must be available to be on campus for meetings as needed.
• Supports the leadership team by fully participating in the Summit Pointe Management System to include maintenance and execution of all assigned key performance indicators as well as annual strategy development and implementation for the Provider Network team.

Qualifications:

Educational

• Bachelor's degree strongly preferred. In lieu of bachelor’s degree, extensive history of working with Medicaid will be considered.

Basic Qualifications

• Minimum of three years of experience in Project Management or project-focused role required.
• Must demonstrate good organizational, computer, communications and problem-solving skills.
• Minimum of five years of experience with computer technology in word processing, spreadsheet development for data tracking, graphic interfaces, web design/content management, database management and electronic medical record/scheduling software and electronic signature software.
• Knowledge of Medicaid billing preferred.

Trauma Informed System of Care:

A trauma-informed approach to service delivery emphasizes physical and emotional safety, choice, empowerment, and trustworthiness for customers. The impact of trauma is broad and touches many life domains. Participation is mandatory for activities required for Summit Pointe to become a “Trauma Informed System of Care.”

Physical Requirements:

• Professional office environment that generates noise from computer equipment/peripherals.
• Possible exposure to health risks (violence and infectious diseases).
• Sometimes lifts, carries, or moves objects up to 25 lbs.
• May be required to work variable hours/shifts.

Summit Pointe introduces a set of competencies tailored to not only enhance your individual growth but also significantly contribute to the success and resilience of our organization. These competencies have been carefully chosen to align with our strategic goals, ensuring that each of our employees is well-equipped to navigate challenges, seize opportunities, and foster a culture of innovation and collaboration. Summit Pointe is invested in the continued growth of its employees to master these competencies. It is not just an investment in your personal and professional development but a key driver for our collective success. As you embark on a journey with Summit Pointe you make a commitment to excellence.

• Innovation & Creativity - Generates new, varied, and unique ideas, and makes connections between previously unrelated ideas.
• Flexibility & Adaptability - Synthesizes and integrates ideas; brainstorms to produce new ideas or results; able to adjust or change to best meet the needs of the situation or environment.
• Verbal Communications - Articulates thoughts and ideas clearly and effectively to exchange information.
• Written Communication - Clearly exchanges information using appropriate platforms to deliver messages.
• Digital Literacy - Leveraging existing digital technologies ethically and efficiently to solve problems, complete tasks and accomplish goals.
• Technical Aptitude - Skillful in use of tools, hardware, software and equipment.
• Critical Thinking & Problem Solving - Exercises sound reasoning to analyze issues, make decisions, and overcome problems. Ability to obtain, interpret, and use knowledge, facts and data.
• Quantitative Reasoning - The application of mathematical, logical and statistical skills to interpret data and produce new information.
• Teamwork & Collaboration - Builds collaborative relationships with colleagues and customers.
• Global Fluency - Demonstrates openness, values differences and practices inclusiveness.
• Professionalism & Work Ethic - Demonstrates personal accountability and effective work habits, e.g., punctuality, working productively with others, and time management.
• Initiative - Independently determining what needs to be done and acting on it.
• Leadership - Leverages the strengths of others to achieve common goals and uses interpersonal skills to coach and develop others.
• Project Management - Initiates, structures, and carries out steps to complete projects and tasks.

Summit Pointe provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

PCN # 515

About Us

Summit Pointe provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Join the Pointe! Join Summit Pointe and join an amazing organization that makes a difference every day in Southwest Michigan!

We are looking for additional team members to be part of our team!

In addition to joining a dedicated, passionate group of people, our employees enjoy the following perks:

• Premium health, dental and vision benefits within 30 days of hire
• Deductible and co-insurance reimbursement program
• Short term disability, long term disability and company paid Employee Assistance Program
• 401(k) match after one year of service
• Social Security alternative contributions
• Free YMCA membership
• Generous paid time off policy
• Ten paid holidays
• Employee appreciation events throughout the year
• Annual performance reviews and opportunities for advancement
• Continuing education reimbursement
• Licensure study materials AND licensure exam reimbursement