Provider Network Specialist

Job Description

MUST BE LOCATED COLORADO (preferably Denver Metro area or CO Springs) 

A bit about this role:

This role will be instrumental in analyzing provider demographic information, financial data, quality reports, and special project data. The ideal candidate will assist the network team in preparing for monthly IPA meetings. The ideal candidate will also have knowledge of provider contracts, claims payments, provider set up, and root cause analysis. A key to success will be someone who has exhibited a proven ability to work independently, while still working with a team, exhibits strong organizational skills and is goal oriented.

Your Responsibilities and Impact will include:

•  Auditing functions: provider set up in Orinoco (demographic and fee schedules), online search tool, print directory, Periscope reports, claims payment. Determine root cause of issues and recommend process improvements. Provide clear analysis and next steps for network team.

• Analysis of network grievances, determination of track and trend or provider outreach, complete outreach as needed, prepare monthly reporting.

• Contracting to support network adequacy in existing and expansion counties. Contract processing, to include: obtaining contract signatures, preparing provider rosters, submitting contract load form.

• Assistance with Field Network cases, outreach to providers, documentation of resolution.

• Evaluate participation requests against network need, current contractual relationships, expansion efforts, access to care. Make recommendations to management. Contract as needed. Respond accordingly to providers.

• Assist network managers with monthly JOC meeting preparations, research outliers in financial reports, audit reports for accuracy, assist with follow up items from meetings.

Required skills and experience:

•  3+ years of direct provider interaction

•  3+ years healthcare experience with medicare advantage or other relevant experience.

•  Proven track record of detail oriented work

•  Ability to navigate Google or MS Suite of products.

•  Experience in claims research, provider set up, root cause analysis, process improvement.

Desired skills and experience: 

• You have the desire to assist network operations in providing excellent service to our providers.

•  You are excited by the fast pace of the organization and accept opportunities for change.

•  You are willing to share your experiences to create best practices.

•  You are skilled at data evaluation, root cause identification, and synopsis.

Salary Range:  $65,000 - $75,000 annually

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.