"Provider Network Specialist - OSU Health Plan"

Job Details

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Scope of Position

This position serves as a Provider Network Specialist on the health plan provider relations team. The Provider Network Specialist reports to the Manager of Provider Network Management and works collaboratively 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 Provider Network Specialist serves as a primary point of contact for OSU Health Plan providers. The Provider Network Specialist collaborates 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 position 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 Provider Network Specialist communicates and collaborates with clinical operations, customer service, and providers. The specialist serves as the liaison between assigned provider specialty areas and health plan clinical operations and customer service departments 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. This position collaborates with clinicians and other Provider Network Management team members on claims payment guidelines and policies and educates internal teams and the provider network on those 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.

Our Comprehensive Employee Benefits Include

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