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The Senior Network Relations Analyst is responsible for the accurate and timely validation and maintenance of critical provider information and inquiries. Staff are responsible for timely review, response, tracking, and routing of provider inquiries received via the Provider Engagement department email box and/or Provider Relationship Management System. Works closely with both internal and external business partners to ensure Provider inquiries are handled within a timely manner. Staff may be responsible for reviewing claims data and information. The Senior Network Relations Analyst is responsible for monthly Access and Availability monitoring as required by state regulatory requirements. Staff ensure adherence to the business and system requirements of internal customers as it pertains to other provider network management areas.
Job Responsibility:
Accurate and timely validation and maintenance of critical provider information and inquiries
Timely review, response, tracking, and routing of provider inquiries received via the Provider Engagement department email box and/or Provider Relationship Management System
Works closely with both internal and external business partners to ensure Provider inquiries are handled within a timely manner
Reviewing claims data and information
Monthly Access and Availability monitoring as required by state regulatory requirements
Ensure adherence to the business and system requirements of internal customers as it pertains to other provider network management areas
Oversees receipt of and coordinates provider inquiries from the provider network
Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided
Audits Rosters received in the provider relations department email box and works closely with the data team to ensure rosters submitted from providers are accurate
Oversees Access & Availability monthly monitoring process
Responsible for reviewing claims data in QNXT when provider's inquiry involves claims payment adjudication
Conducts or participates in special projects and other duties as assigned
Requirements:
A minimum of 2 years' work experience in healthcare
Experience in Medical Terminology, CPT, ICD-10 codes, etc.
Experience working with the MS Office suite (Excel)
Excellent written and verbal communication skills
Travel up to 25%
This position has to reside in KY (within 3 hours of the capital)
Nice to have:
Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, and Network Performance Standards
Bachelor's Degree
What we offer:
Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
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