Provider Network Specialist - OSU Health Plan

The Ohio State University Wexner Medical Center; Columbus (OH); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Generous retirement plan options

Affordable health insurance

Paid vacation and sick leave

Job summary

A leading health care institution in Columbus is seeking a Provider Network Specialist to manage provider relations and optimize access and quality. The role involves investigating claims payment issues and collaborating with various stakeholders. Ideal candidates will have a Bachelor's degree, 2 years of experience, and strong customer service skills. This is a full-time position with comprehensive benefits.

Qualifications

• 2 years of relevant experience required.
• Knowledge of managed care desired.
• Experience with health plan policies and medical terminology required.

Responsibilities

• Serve as primary contact for OSU Health Plan providers.
• Investigate claims payment concerns and provider inquiries.
• Collaborate with clinical operations and customer service.

Skills

Customer service focus

Communication skills

Problem solving

Data analysis

Education

Bachelor's degree or equivalent experience

Job description

Provider Network Specialist - OSU Health Plan

Overview

The Provider Network Specialist serves as a Provider Network Specialist on the health plan provider relations team and reports to the Manager of Provider Network Management. This role works collaboratively with clients, third party administrators, directors, managers, clinicians, and other provider network management team members to optimize access, cost, and quality within our provider networks. The Specialist serves as a primary point of contact for OSU Health Plan providers and collaborates with the Manager of Provider Network Management and the provider relations team to investigate claims payment concerns, resolve provider inquiries, and maintain proactive communication with providers in assigned specialty areas.

Position Summary

The Provider Network Specialist manages the health plan’s provider service operations in collaboration with other departments and third party administrators. The specialist is the primary point of contact for provider, client, and third party administrator inquiries in assigned specialty areas. This position collaborates with Provider Network Management team members, clients, third party administrators, and providers to investigate and resolve provider data discrepancies for web updates, fee schedules, network tiering, and provider demographics and verifies contract information for clients, third party administrators, and providers. The specialist must be able to exercise superior critical thinking and problem solving to research and resolve complex claims payment issues in an accurate and timely manner.

The Provider Network Specialist communicates and collaborates with clinical operations, customer service, and providers. The specialist serves as the liaison between assigned provider specialty areas and health plan clinical operations and customer service departments to ensure effective and efficient provider network operations. The specialist represents the Provider Network Management department at meetings with clients, third party administrators, and providers. This position collaborates with clinicians and other Provider Network Management team members on claims payment guidelines and policies and educates internal teams and the provider network on those guidelines and policies.

Minimum Qualifications

• Bachelor's degree or equivalent experience.
• 2 years of relevant experience required. 2-4 years of relevant experience preferred.
• Demonstrated customer service focus required.
• Knowledge of managed care desired (network design, products, customer service, provider communities).
• Experience in primary care, pediatrics, home care, durable medical equipment, labs, and other ancillary services desired.
• Excellent verbal and written communication skills; strong customer service, interpersonal, conflict resolution, problem solving and program planning skills; strong technology skills; ability to work effectively with all levels of the organization; ability to work independently on assigned projects; ability to analyze and interpret data.
• Experience with health plan policies and medical terminology required.

Benefits

• An array of retirement plan options, each with a generous employer contribution.
• Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.
• Paid vacation and sick leave, including short and long-term disability and paid parental leave.
• Get the most out of the Public Service Loan Forgiveness program.
• And much more!

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Thank you for your interest in working at Ohio State.

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

The university is an equal opportunity employer, including veterans and disability.

Job Details

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Information Technology
• Industries: Hospitals and Health Care