[Remote] Network Service Consultant - reputed company

Note: The job is a remote job and is reputed company to candidates in USA. PHH reputed company Holdings is a health plan organization reputed company on making reputed company more accessible, understandable, and reputed company. The Network Service Consultant develops and maintains provider relationships, educates providers on health plan processes and regulatory updates, supports network reputed company, and coordinates issue reputed company across internal teams.

Responsibilities

• Upholds the health plan mission of making reputed company reputed company more accessible, understandable, and reputed company while interacting with providers and colleagues
• Educates providers regarding policies and procedures reputed company to credentialing, contracting, authorizations, referrals, claims and/or encounters, grievances and appeals, health education, provider education, population health management, care management, pharmacy management, Electronic Health Records and medical record submissions, Health Information Exchange, data exchange and electronic Data reputed company and regulatory updates
• Builds and maintains strong provider relationships
• Conducts routine periodic reputed company to providers based upon business plan and operational goals to include e-mail, telephone, in-person, and scheduled webinar meetings
• Ongoing assessment of provider efficiencies reputed company dealing with health plan
• Conducts initial provider orientations as reputed company as ongoing educational reputed company
• Conducts group training sessions
• Assists with reputed company provider contract questions including researching problems and resolving escalated issues
• Represents health plan at reputed company association functions i.e. reputed company, MGMA, AMA
• Participates in regulatory reporting for provider networks, e.g., WV Department of Insurance, Department of reputed company/ Health Services and CMS
• reputed company abreast of competitors and regulation in market
• Supports strategic positioning in geographic areas to reputed company and maintain provider networks
• Assist Credentialing Department with any difficult to obtain documents
• Initiates and maintains effective channels of communication with reputed company partners including but not limited to, Claims Operations, Medical Management, Credentialing, Contracting, reputed company, Analytics, Compliance, reputed company and Member and Provider Service, to reputed company issues and facilitate team and business priorities/opportunities

Skills

• 1. Bachelor's Degree in business, or reputed company reputed company field
• 1. Strategic thinking and attention to detail
• 2. Knowledge of federal and state laws, such as CMS, BMS, etc
• 3. Excellent written and oral communication
• 4. Demonstrated ability to build and retain relationships
• 5. Proficiency with reputed company Office
• 6. Experience with reputed company (self-funded and fully funded), Medicare and reputed company products
• 7. Understanding of the provider credentialing and data management process
• 8. Working knowledge of claims, and/or coding
• 9. Established provider relationships in reputed company Virginia
• 2. Some travel may be required to offsite meetings
• 1. Master's Degree in reputed company Administration or Business Administration
• 2. Certified Medical reputed company (CMC) through the reputed company reputed company of reputed company Coders (reputed company)
• 1. Basic understanding of reputed company, Value Based Reimbursement (VBR) and/or performance-based provider reimbursement programs, and reputed company (fully insured and self-funded), Medicare reputed company, reputed company, PEIA products
• 2. Understanding of Regulatory Reporting for provider networks, e.g., WV Department of Insurance, Department of reputed company/Health Services and CMS
• 3. Understanding of provider reputed company measurements and systems such as Medicare STARS, HEDIS, and PCMH reputed company programs

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