Provider Network Specialist jobs in Wyoming
Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Provider Network Specialist jobs
Provider Enrollment Specialist (Remote)
- St. John's Health
-
Jackson, WY
FULL_TIME
-
*Remote roles based outside of our primary office in Wyoming can sit in any of the following states: AZ, CO, GA, ID, IL, LA, MI, MO, MT, NV, OK, OR, SC, TN, TX, UT and WA. Please only apply if you are able to live and work primarily in one of the states listed above. State locations and specifics are subject to change as our hiring requirements shift.
Job Summary:
Collaboration with various physicians, leaders, and key parties with payor relationships. Prepare and submit enrollment applications to payors for the purpose of collecting on reassignment of benefits from employed or contracted practitioners. Maintain timelines/calendars on enrollment processes; Communicates and collaborates with providers and other departments as needed; clarifies insurance requests for information; keeps a strict level of confidentiality for all matters pertaining to practitioners. Adheres to and practices the SJH Corporate Compliance Program and participates in performance improvement activities.
Essential Functions:
Initiates contact with practitioners for enrollment purposes; gain delegation authorization to act on behalf of the practitioner in preparing and submitting applications and requirements for payor enrollments. Information includes but is not limited to provider personal identifiers; all state licenses; DEA registration; education, and board certifications required for CMS/ PECOS/CAQH participation. Gathers malpractice insurance and claims data dictated by URAC and NCQA.
Follows up on payer and practitioner inquiries; tracks application submission timelines to monitor for effective dates. Collaborates with Revenue Cycle and multiple key parties. Team member on managed care efforts. Ensures back up appropriately in place.
Respond to internal and external inquiries regarding enrollments as pertains to billers concerns and denials; also works with patients on insurance concerns and payment denials. Works closely with Managed Care items and collaborates with team on payor contracts.
Enrolls and recredentials Teton County Hospital District Entity and dba sites with CMS, Medicaid’s, and all commercial insurances under contract. Updates Medicaid’s and commercial insurances as required with all licensure renewals; facility and practitioner; and malpractice and liability insurance renewals. Enroll facility EFT applications as required.
Consults with Patient Financial Services, Administration, Executive Director of Physician Services, to determine enrollment issues to be addressed. Keep record of Medical Staff services notifications. Maintain MDStaff file in Managed Care Module and shared computer files for non-staff HR practitioners.
Maintains, develops, and updates skills and knowledge to implement ideal service for practitioners, facility, patients, and community.
Job Requirements:
Minimum Education
Preferred: Certified Provider Credentialing Specialist (CPCS) through the National Association Medical Staff Services (NAMSS)
Minimum Work Experience
Required: Effective communication, organization, collaboration, phone, and customer service skills. Must be proficient in Word and Excel
Preferred: Minimum of 5 years of Non-Clinical Healthcare experience, or certification(s) or degree. Knowledge of billing criteria as pertains to enrollments and payor contracts.
Functional Demands:
Working Conditions: Virtual home office, computer use 40 hours week, possible stressful situations related to the interpersonal nature of issues.
Physical Requirements: Sitting/standing 8 hours a day using the computer and phone - Just Posted
Operations Manager - Passenger Transportation - Jackson, WY
- The Driver Provider
-
Jackson, WY
FULL_TIME
- 02Job description The Driver Provider, founded in 1997, is a premier provider of chauffeured transportation services for individuals, corporate clients and event professionals. With offices throughout...
- 1 Month Ago
Future Opening: Telecommunications Tower Technician (Green Hand)
- Larson Tower Specialist
-
Casper, WY
FULL_TIME
- We are seeking a motivated and eager individual to join our team as a Telecommunications Tower Technician (Green Hand). The successful candidate will be responsible for assisting senior technicians wi...
- 7 Days Ago
P/T Office Janitor: Mills, WY
- Eco-Friendly Cleaning Specialist
-
Mills, WY
PART_TIME,CONTRACTOR
- DOT, PIV card holders, perfect part time job!Must have reliable transportation.*Must be willing to submit fingerprints and pass a federal background check*We are looking for a Janitor to carry out cle...
- 18 Days Ago
Future Opening: Experienced Top Hand
- Larson Tower Specialist
-
Casper, WY
FULL_TIME
- Title: Telecommunications Tower Technician Level 3 (top hand)Location: Wyoming We are seeking an experienced and highly skilled Telecommunications Tower Technician to join our team as a Level 3 techni...
- 26 Days Ago
Mid-Level Reclamation Specialist / Ecologist - Lander, WY
- Level Reclamation Specialist / Ecologist - Lander, WY - Tetra Tech Careers
-
Casper, WY
FULL_TIME
- Discover your full potential. At Tetra Tech, we are collaborating with industry-leading experts for a sustainable future for our world. We combine consulting and engineering with advanced analytics an...
- 1 Month Ago
Provider Network Specialist jobs at Popular Companies
Network Engineer
- QinetiQ
-
Reston, VA
- Company Overview We are a world-class team of professionals who deliver next generation technology and products in robot...
- 6/11/2024 12:00:00 AM
Network Technician/Network Engineer/Network Support Engineer(NO C2C CANDIDATES considered)
- Sharp Decisions
-
Graham, NC
- Title : Network Technician/Network Engineer/Network Support Engineer(NO C2C CANDIDATES considered) Contract duration : 1...
- 6/10/2024 12:00:00 AM
Network Engineer
- Kinettix
-
Kahului, HI
- Job Description: Independent Contractor Contract to Hire Job Title: Network Technician Responsibilities: Work a minimum ...
- 6/9/2024 12:00:00 AM
Sr. Specialist Network Engineer
- IT
-
Phoenix, AZ
- Nestlé Information Technology is the digital arm of the world’s largest nutrition, health, and wellness company. With 15...
- 6/8/2024 12:00:00 AM
Network Engineer
- Apex Systems
-
Sumter, SC
- Title of Position: Network Technician Location (city & campus): Sumter, SC (Shaw AFB) Contract Length: 6 month Contract ...
- 6/7/2024 12:00:00 AM
Network Engineer
- Leidos
-
Norfolk, VA
- Description Leidos is a FORTUNE 500 company bringing a mix of innovative technology and sector expertise to customers in...
- 6/7/2024 12:00:00 AM
Network Engineer
- Leidos
-
Arlington, VA
- Description At Leidos, we deliver innovative solutions through the efforts of our diverse and talented people who are de...
- 6/6/2024 12:00:00 AM
Network Engineer
- Leidos
-
North Charleston, SC
- Description Leidos is actively hiring for an experienced Network Engineer to join our team in North Charleston, SC. This...
- 5/31/2024 12:00:00 AM
About Wyoming
Wyoming (/waɪˈoʊmɪŋ/ (listen)) is a state in the mountain region of the western United States. The state is the 10th largest by area, the least populous, and the second most sparsely populated state in the country. Wyoming is bordered on the north by Montana, on the east by South Dakota and Nebraska, on the south by Colorado, on the southwest by Utah, and on the west by Idaho and Montana. The state population was estimated at 577,737 in 2018, which is less than 31 of the most populous U.S. cities including Denver in neighboring Colorado. Cheyenne is the state capital and the most populous city...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$56,323 to $84,208
Most Popular Cities in Wyoming for Provider Network Specialist Jobs
What does a Provider Network Specialist do?
Provider Network Specialist in Anderson, IN
Creates, maintains, and ensures the integrity of the provider data in DHP’s multiple claims payments systems and provider interface programs.
January 07, 2020
Provider Network Specialist in Tucson, AZ
Identifies and works with the provider to address education needs relative to DHP’s new product lines/expansions, utilization management, claims submission, and back-end issues resolution requirements of each assigned provider’s contract.
January 12, 2020
The Provider Network Specialist will work closely with all facets of the business, primarily with Care Management, Claims and Business Development.
January 08, 2020
Provider Network Specialist in Oakland, CA
Build and maintain a successful working relationship with Integra Managed Care and network providers.
December 03, 2019