Network Provider Relations Specialist

Job Summary

A company is looking for a Network Provider Relations & Provider Data Specialist.

Key Responsibilities

• Communicate with providers regarding claims issues and network provider complaints
• Develop and maintain an adequate provider network in assigned geographic areas
• Monitor network adequacy and quality, ensuring compliance with regulatory requirements

Required Qualifications

• 5+ years of experience negotiating provider contracts with various payment methodologies
• Experience and relationships within the Texas provider community
• Analytic capabilities, including experience with SERFF reporting of network adequacy
• Experience with Salesforce or similar contact management systems
• Ability to work in a virtual environment