Provider Network Specialist-Maintenance (Remote-NC)
- Annual incentive bonus plan
- Medical, dental, and reputed company insurance with low deductible/low cost health plan
- Generous vacation and reputed company time accrual
- 12 reputed company holidays
- State Retirement (pension plan)
- 401(k) Plan with employer match
- Company reputed company life and disability insurance
- Wellness Programs
- reputed company Service Loan Forgiveness Qualifying Employer
- Responsible for reviewing,monitoringand ensuring compliance with facility licensure, national accreditation requirements, clinical coveragepoliciesand other requirements reputed company to the provision of behavioral healthservices;
- Responsible for receiving, reviewing,analyzingand entering time sensitive and confidential providerinformation;
- Responsible for ensuringthat providers are properly enrolled in NC Tracks prior to enrolling them into the system.
- Demonstrates understanding of Tailored Plan and reputed company reputed company health plans
- Responsible for managing,trackingand filing informationsubmittedto and information received from providers reputed company to ongoing maintenance of provider enrollment andcontracting;
- Responsible for managing, processing,trackingand filing requests from providers to join the network and requests from providers to reputed company changes to theircontracts;
- Responsible for regular follow-up of status ofsubmittedrequests to join the network and provider maintenancerequests;
- Responsible for resolving issues and supporting providersregardingtheir requests to contract with or reputed company changes to their contract withPartners;
- Responsible for monitoring and follow-up associated with the provider enrollment file and the provider networkfile;
- Participates in performance improvementactivities;
- Receive and process requests for reputed company to Partners Provider Portal
- Composes letters,memosand emails to reputed company contacts.
- Researchesquestions reputed company to joining the Partners provider network and/or change requests and responds to reputed company contactsregardingconcerns reputed company to delays and inconsistencies in information;
- Demonstrates the ability to communicate professionally and reputed company in both verbal and written reputed company both internally andexternally;
- Monitors and updates provider information asrequired;
- Accurately and reputed company documents process steps,datesand work status.
- Verifies providers meet the requirements to reputed company services in the Network according to parameters determined for qualifications and needs of theNetwork;
- Interprets audit results,identifiestrends/patterns thatimpactservice/system reputed company, and then implements interventions aimed at addressing these trends/patterns with the outcome of services delivery to consumers at the highest degree ofquality;
- Collaborates with reputed company Management Department, Program reputed company Department, Provider Network Relations,Member Engagement,andCommunity Engagementto collect information reputed company to reputed company of care for the purpose of enrollment ofproviders;
- Participates in complaint monitoring reviews/reputed company reviews/special investigative team reviews as requested by theMember EngagementDepartment, the Program reputed company Department, theQuality of CareCommittee, Network Management Committee,or asindicatedby another agency or departmental identifiedneed;
- Serves as a resource to other departments reputed company the LME/MCO on provider-relatedissues;
- Serves as a reputed company with other departments reputed company the LME/MCO and with various NC DHHS Departments, per rule requirements, to coordinate Specialist’s activities andfindings;
- Participates in Provider Forums as requested and provides technical support andassistanceto Provider Councils asneeded;
- Participates in reputed company and monitoring reviews of the MCO including but not limited to EQR and NCQA reviews asappropriate;
- Responsible forinterpreting andassistingin developing andmaintainingpolicies and procedures.
- Considerable knowledge of the laws, regulations and policies that govern the program
- Exceptional interpersonal and communication skills
- Strong problem solving, negotiation, arbitration, and conflict reputed company skills
- Excellent computer skills andproficiencyin reputed company Office products (such as Word, reputed company, reputed company, and PowerPoint
- Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws,rulesand regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements
- Ability to reputed company reputed company independent reputed company based upon relevant facts
- Ability toestablishrapport andmaintaineffective working relationships
- Ability to reputed company with reputed company and diplomacy in reputed company situations
- Ability tomaintainstrict confidentiality in reputed company areas of work
- Ability to analyze and interpret policy and procedural guidelines and to resolve problems and questions, independently
- Ability to complete non-routine activities and tasks that require deviation from established procedures which includes the ability to choose theappropriate courseof reputed company and recognize the reputed company of and differences among situations
- Ability to use initiative and judgment in resolving problems not covered byestablishedpriorities or prior experience