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Seeking a Provider Network Management Specialist in Honolulu, Hawaii.
Full-Time opportunity. Monday-Friday, 7:30 am- 4:30 pm.
Hybrid work environment: Work from home remotely and On-site visits at Provider Offices on Oahu and frequently on Kauai.
Description:
Manage both individual and group provider relationships with healthcare plans including provider recruitment, standard contracting, onboarding, claims training and resolution of providers’ issues. Including those related to claims payment, quality and performance initiatives, improved access and controlling unnecessary costs. Ensures that contract and regulatory network adequacy requirements are met by continuously developing new provider relationships while strengthening existing relationships. Supports the implementation of business changes to simplify operations and improve all provider business experiences.
Occasional off-site visits to resolve servicing issues, gather provider market intelligence, contract related concerns and provide education to ensure and strengthen relations with providers. Position is eligible for priority parking. Requires safely operating an insured automobile for travel to off-site locations to conduct and accomplish business related activities. Must have a valid driver’s license, access to an automobile with current license, registration and no fault insurance.
Top Skills' Details:
+5 years of combined experience in healthcare plan operations, medical policy development, and
provider billing practices; with demonstrated ability to explain high-level concepts verbally and in writing.
Bachelor’s degree and two (2) years related experience; or an equivalent combination of education and experience.
• Working knowledge of medical terminology, billing, and claims.
• Project management skills.
• Demonstrated understanding of healthcare plan operations, medical policies and the insurance industry.
Skills:
health insurance, relationship management, healthcare claim, provider support/operations, and medical policy
Additional Skills & Qualifications:
- Need to have a reliable car transportation and current valid driver's license, sporadic driving required: 1-2 times a week.
- Excellent communication and soft skills, ability to resolve issues and build interpersonal relationships.
- Must be RELIABALE and take ownership of assigned providers, primary focusing on Kauai providers and a few Oahu providers.
- Travel dates will vary from 1 to 3 days every month; contingent on scheduled visits to provider offices on Kauai.
Will be joining a team of 6: 1 department manager, 1 team supervisor, 1 lead specialist , and 3 specialists. There will be training of operations and landscape.
Initially, will be partnered with a fellow specialist to shadow provider office visits for the first 3-4 months visits to prepare for future visits independently.
About TEKsystems:We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
