Remote Provider Relations & Data Specialist – NJ

Fidelis Care - New Jersey; New Jersey; On-site; USD 56,000 - 101,000; Full time

Job summary

Fidelis Care - New Jersey seeks a Provider Services professional to ensure accurate provider setup in the information system for state reporting, claims payment, and directories. You will support provider representatives and resolve data issues, serving as a liaison for networks within New Jersey.

The role requires a healthcare-related bachelor's degree and 5+ years in provider services within managed care.

Qualifications

• Bachelor’s degree in healthcare related field or equivalent experience.
• 5+ years of provider services experience in a managed health care environment.
• Experience with provider contracting, benefits interpretation, and provider relations operations.

Responsibilities

• Act as liaison for provider networking and maintain positive relationships with providers and groups.
• Serve as account manager for assigned groups and gatekeeper for internal department interactions.
• Administer and operate contractual provider relationships with accurate databases and training for providers.
• Research, analyze and resolve complex problems in contract loading, financial responsibility interpretation, and contract language.
• Serve as primary point of contact between providers and the health plan.
• Provide issue resolution support for provider contracts by researching and partnering to resolve data issues.
• Act as department subject matter expert.
• Performs other duties as assigned and comply with policies and standards.

Skills

Provider relations

Account management

Data troubleshooting

Contract interpretation

Training providers

Education

Bachelor’s degree in healthcare related field

Job description

Fidelis Care - New Jersey seeks a Provider Services professional to ensure accurate provider setup in the information system for state reporting, claims payment, and directories. You will support provider representatives and resolve data issues, serving as a liaison for networks within New Jersey.

The role requires a healthcare-related bachelor's degree and 5+ years in provider services within managed care.