The Ohio State University
Provider Network Specialist - OSU Health Plan
The Ohio State University, Columbus, Ohio, United States, 43224
Overview
Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu. If you have questions while submitting an application, please review these frequently asked questions. Current Employees and Students:
If you are currently employed or enrolled as a student at The Ohio State University, please log in to Workday to use the internal application process. Welcome to The Ohio State University's career site. We invite you to apply to positions of interest. To ensure your application is complete, you must complete the following: Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required. Prior to submitting your application, review and update (if necessary) the information in your candidate profile as it will transfer to your application. Responsibilities
Job Title:
Provider Network Specialist - OSU Health Plan Department:
OSU Health Plan | Provider Relations The Provider Network Specialist serves on the health plan provider relations team and reports to the Manager of Provider Network Management. This role collaborates with clients, third party administrators, directors, managers, clinicians, and other provider network management team members to optimize access, cost, and quality within our provider networks. The position is the primary point of contact for OSU Health Plan providers and works with the Manager of Provider Network Management and the provider relations team to investigate claims payment concerns, resolve provider inquiries, and maintain proactive communication with providers in assigned specialty areas. Position Summary:
The Provider Network Specialist manages the health plan's provider service operations in collaboration with other departments and third party administrators. The specialist is the primary point of contact for provider, client, and third party administrator inquiries in assigned specialty areas. This role collaborates with Provider Network Management team members, clients, third party administrators, and providers to investigate and resolve provider data discrepancies for web updates, fee schedules, network tiering, and provider demographics, and verifies contract information for clients, third party administrators, and providers. The specialist must be able to exercise superior critical thinking and problem solving to research and resolve complex claims payment issues in an accurate and timely manner. The Specialist communicates with clinical operations, customer service, and providers, and serves as the liaison between assigned provider specialty areas and health plan clinical operations and customer service to ensure effective and efficient provider network operations. The specialist represents the Provider Network Management department at meetings with clients, third party administrators, and providers and educates internal teams and the provider network on claims payment guidelines and policies. Minimum Qualifications
Bachelor's degree or equivalent experience.
2 years of relevant experience required. 2-4 years of relevant experience preferred.
Demonstrated customer service focus required.
Knowledge of managed care desired (network design, products, customer service, provider communities).
Experience in primary care, pediatrics, home care, durable medical equipment, labs, and other ancillary services desired.
Excellent verbal and written communication skills; strong customer service, interpersonal, conflict resolution, problem solving and program planning skills; strong technology skills; ability to work effectively with all levels of the organization; ability to work independently on assigned projects; ability to analyze and interpret data.
Experience with health plan policies and medical terminology required.
Benefits
An array of retirement plan options, each with a generous employer contribution.
Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.
Paid vacation and sick leave, including short and long-term disability and paid parental leave.
Get the most out of the Public Service Loan Forgiveness program.
And much more!
Additional Information
Location:
Ackerman Rd, 700 (0921) Position Type:
Regular Scheduled Hours:
40 Shift:
First Shift Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process. Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, you can find the most updated information on the status of your application by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the frequently asked questions. The university is an equal opportunity employer, including veterans and disability. As required by Ohio Revised Code section 3345.0216, Ohio State will educate students by means of free, open and rigorous intellectual inquiry to seek the truth; equip students with the opportunity to develop intellectual skills to reach their own, informed conclusions; not require, favor, disfavor or prohibit speech or lawful assembly; create a community dedicated to an ethic of civil and free inquiry, which respects the autonomy of each member, supports individual capacities for growth and tolerates differences in opinion; treat all faculty, staff and students as individuals, hold them to equal standards and provide equality of opportunity with regard to race, ethnicity, religion, sex, sexual orientation, gender identity or gender expression. #J-18808-Ljbffr
Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu. If you have questions while submitting an application, please review these frequently asked questions. Current Employees and Students:
If you are currently employed or enrolled as a student at The Ohio State University, please log in to Workday to use the internal application process. Welcome to The Ohio State University's career site. We invite you to apply to positions of interest. To ensure your application is complete, you must complete the following: Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required. Prior to submitting your application, review and update (if necessary) the information in your candidate profile as it will transfer to your application. Responsibilities
Job Title:
Provider Network Specialist - OSU Health Plan Department:
OSU Health Plan | Provider Relations The Provider Network Specialist serves on the health plan provider relations team and reports to the Manager of Provider Network Management. This role collaborates with clients, third party administrators, directors, managers, clinicians, and other provider network management team members to optimize access, cost, and quality within our provider networks. The position is the primary point of contact for OSU Health Plan providers and works with the Manager of Provider Network Management and the provider relations team to investigate claims payment concerns, resolve provider inquiries, and maintain proactive communication with providers in assigned specialty areas. Position Summary:
The Provider Network Specialist manages the health plan's provider service operations in collaboration with other departments and third party administrators. The specialist is the primary point of contact for provider, client, and third party administrator inquiries in assigned specialty areas. This role collaborates with Provider Network Management team members, clients, third party administrators, and providers to investigate and resolve provider data discrepancies for web updates, fee schedules, network tiering, and provider demographics, and verifies contract information for clients, third party administrators, and providers. The specialist must be able to exercise superior critical thinking and problem solving to research and resolve complex claims payment issues in an accurate and timely manner. The Specialist communicates with clinical operations, customer service, and providers, and serves as the liaison between assigned provider specialty areas and health plan clinical operations and customer service to ensure effective and efficient provider network operations. The specialist represents the Provider Network Management department at meetings with clients, third party administrators, and providers and educates internal teams and the provider network on claims payment guidelines and policies. Minimum Qualifications
Bachelor's degree or equivalent experience.
2 years of relevant experience required. 2-4 years of relevant experience preferred.
Demonstrated customer service focus required.
Knowledge of managed care desired (network design, products, customer service, provider communities).
Experience in primary care, pediatrics, home care, durable medical equipment, labs, and other ancillary services desired.
Excellent verbal and written communication skills; strong customer service, interpersonal, conflict resolution, problem solving and program planning skills; strong technology skills; ability to work effectively with all levels of the organization; ability to work independently on assigned projects; ability to analyze and interpret data.
Experience with health plan policies and medical terminology required.
Benefits
An array of retirement plan options, each with a generous employer contribution.
Affordable health insurance options, including dental, vision and prescription coverage that begin on day one.
Paid vacation and sick leave, including short and long-term disability and paid parental leave.
Get the most out of the Public Service Loan Forgiveness program.
And much more!
Additional Information
Location:
Ackerman Rd, 700 (0921) Position Type:
Regular Scheduled Hours:
40 Shift:
First Shift Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process. Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, you can find the most updated information on the status of your application by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the frequently asked questions. The university is an equal opportunity employer, including veterans and disability. As required by Ohio Revised Code section 3345.0216, Ohio State will educate students by means of free, open and rigorous intellectual inquiry to seek the truth; equip students with the opportunity to develop intellectual skills to reach their own, informed conclusions; not require, favor, disfavor or prohibit speech or lawful assembly; create a community dedicated to an ethic of civil and free inquiry, which respects the autonomy of each member, supports individual capacities for growth and tolerates differences in opinion; treat all faculty, staff and students as individuals, hold them to equal standards and provide equality of opportunity with regard to race, ethnicity, religion, sex, sexual orientation, gender identity or gender expression. #J-18808-Ljbffr