About the Role
We're looking for a detail-oriented Medical Network Representative to serve as a trusted point of contact between our organization and our provider community. In this role, you'll research and resolve complex provider issues, coordinate claims resolution, support contracting and credentialing activities, and help ensure providers are paid accurately and on time. This is a great opportunity for someone with healthcare administration or provider relations experience who enjoys problem-solving and working with data.
What You'll Do
- Serve as the primary point of contact for internal departments on provider issues affecting provider satisfaction.
- Research and resolve complex provider issues and appeals, ensuring prompt and accurate resolution.
- Coordinate claims resolution through direct contact with providers and the claims department.
- Conduct periodic on-site provider visits as needed.
- Provide guidance on policy interpretation and respond to provider questions about billing, pricing, and reimbursement.
- Research, analyze, and recommend solutions for provider disputes, billing issues, and operational practices.
- Process provider demographic updates and other account changes.
- Identify and report on provider utilization patterns that impact service quality.
- Verify that providers are paid according to their contracted terms.
- Support provider network and contracting activities, including data analysis and reporting.
What You Bring
- High school diploma, GED, or equivalent required.
- Minimum of 3 years of customer service experience, or an equivalent combination of education and experience.
- Strong oral, written, and interpersonal communication skills.
- Strong problem-solving, facilitation, and analytical skills.
- Proficiency in Microsoft Excel, Outlook, Word, and Teams.
- Comfortable learning new systems and processes.
- Excellent attention to detail and ability to manage large volumes of data.
- Ability to work independently and manage multiple assignments in a fast-paced environment.
Preferred Qualifications
- Experience in healthcare administration, provider relations, network operations, contract management, or data analysis.
- Experience working with healthcare providers, contracts, credentialing, or claims operations.
- Bilingual in English and Spanish strongly preferred.
Schedule
Monday through Friday, 8:00 AM – 5:00 PM
Work Location
Hybrid — 2-4 days per week onsite
Tipo de puesto: Tiempo completo
Sueldo: $16.00 la hora
Escolaridad:
Experiencia:
- customer service: 3 años (Deseable)
- Strong problem-solving: 3 años (Deseable)
- Strong interpersonal communication skills: 3 años (Deseable)
Lugar de trabajo: Empleo presencial
