Delegated Provider Network Specialist
Embrace better opportunities.
Are you passionate about health, happiness and helping others? So are we.
We're committed to helping our health plan Members live a happy and healthy lifestyle, and we believe that it starts here first, with our Associates.
At AvMed, we provide the tools and opportunities to enhance, expand, and support each Associate's personal and professional growth.
From tuition reimbursement to exercise classes in the office, embrace a better career with AvMed and join our team!Position:
Delegated Provider Network SpecialistScope of position:
The Delegated Provider Network Specialist will work in conjunction with the Senior Manager, Delegated Provider Network, to support the development and execution of the Network Department.
Support strategies related to implementation and monitoring to optimize results and profitability.
The associate will also resolve internal issues in a timely, effective, and responsive manner, and assist in the renegotiation process.
The delegate provider network for which the Delegated Provider Network Specialist is responsible will have high provider and member satisfaction, be cost effective and demonstrate a high level of compliance with AvMed quality initiative.
Essential Job Functions:
Provide service, support, and education to the delegated providers networks.
Coordinates with Provider Data Contract Management and other pertinent departments to ensure all contractual language is configured correctly for accurate encounter adjudication.
Coordinate with Health Economic Department the production of the quarterly encounter reports.
Analyze the financial information to assess profitability and stability of the delegated vendors.
Identify risks, respond to, resolve issues, errors and escalate situations as needed.
Handle escalated service forms from Member Services/Provider Service Center.
Solves complex problems and develops innovative solutions.
Review results post delegated network implementation to ensure projected cost savings are realized and resolve and/or escalate issues.
Assist in other analysis related to capitation Leakage, project cost saving targets based on negotiated rates, etc.
Support in the new provider Network implementations which includes interfacing with multiples areas in the organization such as IT, Claims, Medical pharmacy, and Data Management to ensure provider network are administer.
Coordinate annual JOC meetings.
Maintain an annual calendar, update when necessary and keep minutes of each meeting.
Support in the RFP for desired provider networksDemonstrates strong organizational and analytic skills.
Perform additional duties and responsibilities as assigned by management.
We Offer:
Competitive Salaries Comprehensive
Benefits:
Medical Plans, Health Savings Account, Dental, Vision, and more Paid Time Off, Company Paid Holidays, Paid Time Off Cash-In 401(k)plan with matching contributions, Tuition Assistance, Associate Discounts You have:
Associates required Bachelor's in business administration or healthcare related field, preferred related field required 3-5 years of Highly experienced in healthcare regulations, accreditation standards, and compliance requirements.
Strong analytical skills with the ability to interpret data and identify areas of improvement.
You May Also Have:
Minimum of 3 years of healthcare contract negotiation experience, with direct contact with physicians/facilities and office staff.
Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structure and reimbursement rate to providers.
Able to create comprehensive Excel data spreadsheets, work with Excel formulas, and create reports.
Excellent verbal and written communication skills Proficient in Microsoft Word, Outlook, Excel, and PowerPoint Proficient in Microsoft Windows environment Basic claims payment system knowledge Well organized, with the ability to handle multiple and competing priorities Environment:
At AvMed, you will find a family.
Our Associates love all the opportunities for advancement, the flexible work environment and team activities.
We also encourage our Associates to embrace a life rich in what matters most - health and happiness.
We call it being WELLfluent.
Join AvMed.
Join the WELLfluent!Location:
Doral, Florida Location:
Location:
This position is hybrid 2 days onsite if within local market or 100% remote if outside of local territory.
AvMed is a tobacco/drug free workplace, EOE Recommended Skills Analytical Business Administration Claim Processing Communication Contract Management Coordinating Estimated Salary: $20 to $28 per hour based on qualifications.
Are you passionate about health, happiness and helping others? So are we.
We're committed to helping our health plan Members live a happy and healthy lifestyle, and we believe that it starts here first, with our Associates.
At AvMed, we provide the tools and opportunities to enhance, expand, and support each Associate's personal and professional growth.
From tuition reimbursement to exercise classes in the office, embrace a better career with AvMed and join our team!Position:
Delegated Provider Network SpecialistScope of position:
The Delegated Provider Network Specialist will work in conjunction with the Senior Manager, Delegated Provider Network, to support the development and execution of the Network Department.
Support strategies related to implementation and monitoring to optimize results and profitability.
The associate will also resolve internal issues in a timely, effective, and responsive manner, and assist in the renegotiation process.
The delegate provider network for which the Delegated Provider Network Specialist is responsible will have high provider and member satisfaction, be cost effective and demonstrate a high level of compliance with AvMed quality initiative.
Essential Job Functions:
Provide service, support, and education to the delegated providers networks.
Coordinates with Provider Data Contract Management and other pertinent departments to ensure all contractual language is configured correctly for accurate encounter adjudication.
Coordinate with Health Economic Department the production of the quarterly encounter reports.
Analyze the financial information to assess profitability and stability of the delegated vendors.
Identify risks, respond to, resolve issues, errors and escalate situations as needed.
Handle escalated service forms from Member Services/Provider Service Center.
Solves complex problems and develops innovative solutions.
Review results post delegated network implementation to ensure projected cost savings are realized and resolve and/or escalate issues.
Assist in other analysis related to capitation Leakage, project cost saving targets based on negotiated rates, etc.
Support in the new provider Network implementations which includes interfacing with multiples areas in the organization such as IT, Claims, Medical pharmacy, and Data Management to ensure provider network are administer.
Coordinate annual JOC meetings.
Maintain an annual calendar, update when necessary and keep minutes of each meeting.
Support in the RFP for desired provider networksDemonstrates strong organizational and analytic skills.
Perform additional duties and responsibilities as assigned by management.
We Offer:
Competitive Salaries Comprehensive
Benefits:
Medical Plans, Health Savings Account, Dental, Vision, and more Paid Time Off, Company Paid Holidays, Paid Time Off Cash-In 401(k)plan with matching contributions, Tuition Assistance, Associate Discounts You have:
Associates required Bachelor's in business administration or healthcare related field, preferred related field required 3-5 years of Highly experienced in healthcare regulations, accreditation standards, and compliance requirements.
Strong analytical skills with the ability to interpret data and identify areas of improvement.
You May Also Have:
Minimum of 3 years of healthcare contract negotiation experience, with direct contact with physicians/facilities and office staff.
Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structure and reimbursement rate to providers.
Able to create comprehensive Excel data spreadsheets, work with Excel formulas, and create reports.
Excellent verbal and written communication skills Proficient in Microsoft Word, Outlook, Excel, and PowerPoint Proficient in Microsoft Windows environment Basic claims payment system knowledge Well organized, with the ability to handle multiple and competing priorities Environment:
At AvMed, you will find a family.
Our Associates love all the opportunities for advancement, the flexible work environment and team activities.
We also encourage our Associates to embrace a life rich in what matters most - health and happiness.
We call it being WELLfluent.
Join AvMed.
Join the WELLfluent!Location:
Doral, Florida Location:
Location:
This position is hybrid 2 days onsite if within local market or 100% remote if outside of local territory.
AvMed is a tobacco/drug free workplace, EOE Recommended Skills Analytical Business Administration Claim Processing Communication Contract Management Coordinating Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
