Provider Network Specialist — Remote/Onsite Relations

US Family Health Plan- A TRICARE Prime option; New York (NY); Ibrido; USD 70.000 - 75.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

Vision coverage

Dental benefits

Life and disability insurance

401(k) with employer match

Commuter benefits

Tuition reimbursement

Vacation time, holidays, personal days

Employee discounts

Employee Assistance Program

Descrizione del lavoro

US Family Health Plan- A TRICARE Prime option is seeking a Provider Network Specialist to build and maintain strong relationships with healthcare providers and ensure provider satisfaction.

You will serve as the primary contact between providers and internal departments, supporting network performance and ensuring compliance with contractual and regulatory requirements, while educating providers on policies and TRICARE guidelines.

Competenze

• 5-8 years’ experience in health insurance, provider network or provider contracting.
• Access to personal vehicle and valid driver’s license.
• Able to lift 20 pounds.
• High school diploma required; associate’s degree preferred.

Mansioni

• Educate providers on Plan policies, procedures, billing guidelines and TRICARE requirements.
• Support onboarding and orientation of newly contracted providers and participate in ongoing training.
• Monitor network adequacy and respond to gaps, access and availability.
• Collaborate with internal departments to resolve provider issues and ensure beneficiary needs.
• Assist providers with claims resolution, credentialing inquiries, contract interpretation and system navigation.
• Track provider inquiries, issues and trends; report to management.
• Communicate with prospective and contracted providers; conduct site visits (virtual or in-person).
• Maintain accurate documentation of provider interactions and contacts.
• Partner with marketing/sales teams for market growth and brand recognition.
• Analyze provider performance metrics and support quality initiatives with the Quality Department.

Conoscenze

Interpersonal skills

Organizational skills

Presentation skills

Verbal and written communication

Data entry

Multitasking

Medical terminology

Salesforce

Microsoft Office

Access

Formazione

High School Diploma Required

Associate’s Degree Preferred

Strumenti

Microsoft Office

Access

Salesforce

Descrizione del lavoro

US Family Health Plan- A TRICARE Prime option is seeking a Provider Network Specialist to build and maintain strong relationships with healthcare providers and ensure provider satisfaction.

You will serve as the primary contact between providers and internal departments, supporting network performance and ensuring compliance with contractual and regulatory requirements, while educating providers on policies and TRICARE guidelines.