Provider Network Specialist (Fully Remote)

May 9, 2024

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Job Description

Position Title – Provider Network Specialist
Address – Remote…
Pay- $19-$24 an hour
Hours – Monday – Friday (Either 8-4:30 EST or 8:30-5 EST – includes a 30 min lunch break)
(Must sit on the East Coast)
? *2-3 Month Contract with possible extension**
Job Summary:
Network Specialist – Network adequacy and contracting is critical to ensuring members have access to high quality care, and that our products are regulatory compliant to be sold in the marketplace. This role will be responsible for supporting the organization to achieve network adequacy, member experience and provider goals – in both new and existing markets – by directly engaging with and contracting with providers. Additionally, team members will have the opportunity to build relationships with key providers in the market, and will triage and problem solve issues as they arise.
Responsibilities:
? Understand and know the provider landscape for the assigned market (eg. know providers in and out of network, know the network gaps, including provider groups that are missing and potential additional groups for recruitment, etc)
? Develop familiarity with P&L?s contracting guardrails and workflows, including key terms and rate structures for Oscar?s provider agreements
? Support the P/L team to close the contracting needed to complete a network construction plan
? Close network gaps (member experience, provider experience and regulatory) and single case agreements by identifying, sourcing, and contracting with providers in a region
? Be a resource for the P/L team to support provider relationships
? Develop familiarity with core provider operational workflows and tools (basic claims escalations, fee schedule request, updated roster information, provider portal set up and maintenance, ACH/EFT set up, etc.) and be able to identify & flag trends for escalation.
? Document and share provider feedback, objections and questions to support the continuous improvement of Oscar?s contracting templates and processes.
? Support the P/L team on additional network improvement initiatives as identified
Qualifications:
? Bachelors or associate degree, or 1+ years healthcare or healthcare related field
? Familiarity with Word, Excel, and Powerpoint (or Google suite equivalent)
? Strong written and verbal communication skills
? Strong organizational and follow-through capabilities
? Bonus Points
? Experience in a customer support/customer service role
? Experience negotiating
About Medix?
Medix is dedicated to positively impacting lives every day. Since 2001, we have made it our mission to be the leading provider of workforce solutions for clients and candidates across the Healthcare, Scientific, and Information Technology industries.
Our dedicated recruiters are here to help you find and secure just the right opportunity. We take the time to learn about you, your skills, your interests, and your career goals, and then match you with the jobs and companies that best suit your needs. Whether you are looking for a contract, contract-to-hire, or direct hire positions, we can help you to find the meaningful and gratifying work that you’ve been looking for. Let Medix be your partner as you move your career forward. Contact us today!

Benefits

Once you have been a contract employee of Medix for 30 days, you become eligible for our Benefits Program. Should you elect to enroll, there are three levels of medical coverage to choose from, supplemental dental plans and term plans as well as the option to enroll your spouse and/or children. You can select the best combination that best suits your needs.

As a contract employee with Medix, you can choose to enroll in our Benefits Program during your eligibility period and enjoy:
? Minimum Essential Coverage (MEC) plan
? Two different fixed indemnity plan add-ons
? Major Medical Plans, including 1 HSA Plan
? Dental
? Vision
? Short-term disability
? Life and AD&D

Job Type: Full-time

Pay: $19.00 – $24.00 per hour

Expected hours: 40 per week

Benefits:
? 401(k)
? Dental insurance
? Health insurance
? Paid time off
? Vision insurance

Schedule:
? 8 hour shift
? Monday to Friday

Location:
? Georgia (Required)

Work Location: Remote

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