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Provider Operations Specialist
Location:
Statewide
Description:
Imagine360 is currently seeking a Provider Operations Specialist to join the team ! The Provider Operations Specialist is r esponsible for operationalizing new and existing provider contracts. Primary accountabilities will include (i) loading the executed provider contracts into the claims and contract system (ii) ensuring quality of loaded contracts (iii) working closely with the claims pricing team to test loaded contracts (iv) ensuring physician/health system contracts are being adhered to and (v) troubleshoots claim pricing issues related to contract set up and operationalization. Position Location : 100% Remote Responsibilities include but are not limited to: Assists with loading and testing of provider contracts across existing claims processing systems. Support other operations resources in the setup of new contracts, fee schedules, contract amendments or provider demographic updates. Coordinate with Provider Engagement to track and implement annual contract rate updates as needed. Triage and handle any claims pricing inquires related to contract programming and coordinate next steps across various departments for resolution. Audit contract load completion and adherence to contract terms. Review and coordinate with team members to ensure provider demographic data included with contracts aligns with the corresponding reimbursement agreements Contribute to quality improvement recommendations and develop documentation and training materials. Adhere to standards for claims and contract loading turnaround timelines Understanding department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Provide feedback on system limitations or expansion needs as a user of provider management database. Participate in any testing and validation of system changes and improvements. Other duties as assigned. Required Experience / Education: Associates Degree 1+ years experience Experience working in a managed care/ health care environment. Extensive Professional Provider and/or Facility reimbursement experience required. Experience creating fee schedules. Understanding of complex provider contracts. Knowledge of binding terms and provisions in a contract. Functional knowledge of payment methodology. Experience with contract loading systems which involve interpreting and programming reimbursement methodologies Must possess strong analytical and problem-solving skills. Must be familiar with Medicare and Commercial reimbursement methodologies Must possess strong verbal and written communication skills Want to see our latest job opportunities? Follow us on LinkedIn Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions. Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. **RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**
Company:
Imagine360
Posted:
December 26 2023 on ApplicantPro
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More About this Listing: Provider Operations Specialist
Provider Operations Specialist is a Jobs Operations Specialist Job at Imagine360 located in United States. Find other listings like Provider Operations Specialist by searching Oodle for Jobs Operations Specialist Jobs.
Provider Operations Specialist is a Jobs Operations Specialist Job at Imagine360 located in United States. Find other listings like Provider Operations Specialist by searching Oodle for Jobs Operations Specialist Jobs.