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Senior Network Services Specialist

Remote:

Full Remote

Contract:

Full time

Experience:

Junior (1-2 years)

Work from:

United States

Offer summary

Qualifications:

HS Diploma, Minimum of 1 years' healthcare experience, Working knowledge of health care delivery, Excellent PC skills preferred, Ability to manage multiple priorities.

Key responsabilities:

Liaison for providers, payers, and departments
Review and resolve grievance issues
Conduct follow-up on resolved issues
Promote MedCost strengths to providers
Assist with customer service inquiries

MedCost LLC Insurance SME https://www.medcost.com/

201 - 500 Employees

See more MedCost LLC offers

Job description

Position Summary:

The Senior Network Services Specialist, Network Management is responsible for building and maintaining a positive relationship with network providers/payers by assisting with daily inquiries, complaints, appeals, grievances, and educational efforts. This includes any other issues that are necessary to promote excellent customer service with internal and external customers.

Position Responsibilities:

Serve as a liaison for providers, payers and internal departments on the resolution of inquiries related to the business unit’s functions. This includes education or communication to members of the Network Management department, as needed.
Review and resolve grievance related issues submitted to MedCost and its departments requiring verbal, written, and on-site communication.
Proactively research and resolve issues to avoid future escalation.
Work with Management regarding escalated issues to achieve full resolution.
Conduct verbal, written, or on-site post-grievance follow-up to ensure issues and concerns are fully resolved.
Promotes MedCost strengths to the provider community whenever possible and represent the organization with integrity.
Prioritize excellent customer service with each interaction.
Provide feedback to MedCost and its various department based on information gathered from network providers and identify issues that can possibly decrease provider satisfaction with MedCost.
Assist with completion of Customer Service inquiries within 5 business days.
Maintain compliance with MedCost Policies and Procedures, URAC and North Carolina Department of Insurance regulations.
Back up to produce end of month reports for management review.
Relationship Maintenance of all network providers, internal and external customers.
Support business unit by completing other tasks as requested.
Other duties as assigned

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Position Qualifications:

Required

HS Diploma
Minimum of 1 years' experience in healthcare field

Preferred

College degree, but not required.

Skills, Knowledge And Abilities

Working knowledge of the health care delivery system and the managed care environment;
Strong interpersonal, verbal and written communication skills;
Excellent organizational and time utilization skills;
Provide accountability in a fair and respectful manner;
Ability to represent MedCost in a positive manner in difficult situations;
Excellent PC skills with Microsoft Word, Excel, Access, PowerPoint and Outlook preferred;
Ability to manage multiple items effectively with varying priorities;
Ability to work with other departments and external clients in an efficient and congenial manner;
Ability to ensure high administrative service quality;
MedCost claims processing experience helpful;
Claims and Customer Service experience helpful;
Ability to think and work effectively, anticipate needs and demonstrate resourcefulness;
Ability to accurately complete tasks within established times;
Daily and overnight travel;
Superior attendance record;
Provider background knowledge helpful.

Key Competencies

Service orientation
Integrity
Ethical practice and confidentiality

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.