Rep, Network Contract Support at Claritev
United States
<p><strong><em><u>Network Contract Specialist</u></em></strong></p> <p> </p> <p>At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive <em>to <strong>bend the cost curve in healthcare</strong></em> for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.</p> <p>Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!</p> <p> </p> <p><strong><u>DUTIES</u></strong></p> <ol> <li><em>Process provider nominations within established guidelines.</em></li> <li><em>Address and resolve issues that can be remedied within clearly defined guidelines, procedures and policies.</em></li> <li><em>Consult with Network Development negotiator to resolve more complex escalated issues and coordinate activities to support the resolution of said issues. Contact providers to discuss network participation, contract compliance and overcome potential objections.</em></li> <li><em>Educate providers regarding contract terms, contract rate, procedures and contract requirements. Manage alchemy contract retrieval processes.</em></li> <li><em>Use approved contractual and communication documents in accordance with policies and procedures to support existing and proposed product portfolio.</em></li> <li><em>Responsible for small group and individual provider contract negotiations. Maintain good working relationships with providers.</em></li> <li><em>Support pre-credentialing functions for small group contracts. Support pre-credentialing functions for ancillaries, facilities and individual providers as determined by company/department initiatives.</em></li> <li><em>Develop plans and goals for projects within assigned scope.</em></li> <li><em>Make recommendations as appropriate to Regions with regard to specific providers, issues and trends. Communicate with operational areas regarding resolution of issues.</em></li> <li><em>Track inquiries and resolution; maintain database of escalated provider issues; and prepare periodic reports summarizing network issues.</em></li> <li><em>Collaborate, coordinate, and communicate across disciplines and departments.</em></li> <li><em>Ensure compliance with HIPAA regulations and requirements.</em></li> <li><em>Demonstrate Company’s Core Competencies and values held within.</em></li> <li><em>The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.</em></li> </ol> <p><em> </em></p> <strong><span>Qualifications</span></strong> <p><strong><u>REQUIREMENTS</u></strong></p> <ul> <li><em>Minimum high school diploma or G.E.D.</em></li> <li><em>Minimum 2 years customer service or provider communication experience (preferably within the health care industry) including direct experience working with provider data, reimbursement methodology and provider communication.</em></li> <li><em>Knowledge of medical codes, negotiations and contract terminology preferred</em></li> <li><em>Communication (written, verbal and listening), negotiation, organization and time management skills</em></li> <li><em>Ability to use software, hardware and peripherals related to job responsibilities, including MS Office</em></li> <li><em>Ability to establish priorities when faced with multiple, critical tasks</em></li> </ul> <p><em> </em></p> <p> </p> <p><strong><u>EEO STATEMENT</u></strong></p> <p>Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please <a href="https://cdn.complyright.com/Email_Images/PosterGuard/2022/PDF/22-088_EEOC_KnowYourRights_10_20.pdf">click <strong>here</strong></a>.</p> <p> </p> <p> </p> <p><strong><u>APPLICATION DEADLINE</u></strong></p> <p>We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.</p> <p> </p> <p>#LI-KB1</p>
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