Network Relations Coordinator (Non-Exempt Remote/Hybrid/On-site)

POSITION SUMMARY

Responsible for maintaining working relationships within the existing network. Assist in the recruitment of new providers. Responsible for pricing and issues with pricing. Assist with policy and procedure interpretation.

RESPONSIBILITIES

• Answer, direct and resolve phone calls related to: -Claims Status from Repricing -Network Status -Occasional main phone line backup
• Re-price claims.
• Determine network participation for claims purposes (e.g. Claimsbridge, TPA)
• Act as liaison between payors and providers.
• Act as resource to QCP staff related to provider issues that arise.
• Research and resolve Claimsbridge denials and any associated claims issues.
• Negotiate with non-contracted providers and complete associated documentation to allow for billing % of savings.
• Non-contracted providers(s) review, reach out, follow-up, etc. -OPPOC non-contracted provider(s), research, reach out and inquiries -QCP non-contracted provider(s) reach out and inquiries
• Other duties as assigned.

REQUIRED QUALIFICATIONS

• High school degree or equivalent required.
• Bachelor of Science in communications, marketing or healthcare related field preferred or equivalent experience.
• Previous 2 years experience in healthcare billing, coding, insurance follow up or other medical office experience relevant to provider claim processes and follow up.
• Certified Coder preferred.

TRAITS AND APTITUDES

• High level of awareness of pertinent details;
• excellent organizational skills;
• Strong analytic and problem-solving abilities;
• Effective and efficient oral and written communication skills.
• Knowledge of ICD-9/10 and CPT codes required;
• Must handle pressure effectively;
• Professional appearance and demeanor;
• Able to maintain confidentiality;
• Able to use PC software (Microsoft Office-Excel, Word, PowerPoint) with the ability to master programs needed for position.

PHYSICAL DEMANDS AND WORK CONDITIONS

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Must have excellent written and verbal communication skills as well as the ability to observe, assess, guide and evaluate others.
• Must be able to hear, speak, and see and to coordinate motor skills.
• Must be able to climb, lift 25 pounds, stoop and bend and reach above head.
• Able to collect data, interpret findings, set priorities and carry out established plan.
• Able to read, write and utilize manual and computerized systems of documentation.
• Must read a significant amount of information in a relatively short period of time.

EEO STATEMENT

Quality Care Partners is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics.

REPORTING RELATIONSHIPS

Position Reports to: Director of Network Development