🚀 Provider Network Consultant

Overview

This position analyzes, researches, and applies business rules to complete requests from providers regarding adds/deletes/changes to information used for claims processing, membership assignment, and directory purposes. It involves contracting, credentialing, and maintaining Facility/Professional provider data to support marketing and network contracting across all lines of business. The role supports the implementation of special projects, assists with tracking project phases, and manages workflow. It also includes helping management familiarize and train team members with the various business rules in network contracting and credentialing, and identifying gaps in processes with suggested improvements.

Required Job Qualifications

• HS Diploma/GED (education verification required) plus 1 year of experience with Provider Network contracting and credentialing systems OR 5 years of experience in the Health Care industry.
• Written and verbal communication skills including interpersonal skills.
• Skills to develop training materials and act as an advisor to staff.
• Experience and proficiency in Microsoft Office software products including analytical tools.

Preferred Job Qualifications

• Subject Matter Expert for the Professional Provider Credentialing Process.
• 2 years of experience with current government sponsored health insurance networks.
• Knowledge of health care delivery systems, claim costing analytics, and provider network adequacy analytics.

Seniority level

• Associate

Employment type

• Contract

Job function

• Administrative

Industries

• Hospitals and Health Care

Location: Albuquerque, NM

Salary: $50,225.00 - $75,335.00