Senior Provider Engagement Specialist

Job Summary

A company is looking for a Senior Provider Engagement Network Specialist.

Key Responsibilities

• Ensure accurate setup of providers in the information system for reporting and claims payment
• Act as the internal and external liaison for provider networking and manage relationships with participating providers
• Research and resolve complex provider-related issues, including contract interpretation and claims disputes

Required Qualifications

• Bachelor's degree in a healthcare-related field or equivalent experience
• 5+ years of provider services experience in a managed healthcare environment
• Experience with provider contracting and servicing benefits interpretation
• Familiarity with claims/provider data platforms, such as Xcelys and Amisys
• Analytical and reporting experience related to internal operations and claims