Provider Network Specialist

📋 Description

• • Devoted Health is seeking a highly organized and detail-oriented Provider Network Specialist to join our growing team. This fully remote role, based in Colorado, is crucial for ensuring the smooth operation and expansion of our provider network. You will play an instrumental role in analyzing critical provider data, including demographic information, financial performance, quality reports, and data from special projects. Your insights will directly support the network team in preparing for essential monthly IPA (Independent Practice Association) meetings, ensuring all stakeholders have accurate and timely information.
• • The ideal candidate will possess a strong understanding of provider contracts, claims payment processes, provider setup procedures, and the ability to conduct thorough root cause analysis. Success in this position hinges on your proven ability to work autonomously while also collaborating effectively within a team environment. Exceptional organizational skills and a goal-oriented mindset are paramount to thriving in this dynamic role.
• • Your responsibilities will encompass a wide range of auditing functions. This includes meticulously auditing provider setup within our internal systems like Orinoco, verifying demographic data and fee schedules, and ensuring accuracy in our online search tools and print directories. You will also be responsible for reviewing Periscope reports and claims payments, identifying discrepancies, and performing root cause analysis to pinpoint the origins of issues. Based on your findings, you will recommend actionable process improvements and provide clear, concise analysis with recommended next steps to the network team.
• • A significant aspect of this role involves analyzing network grievances. You will be responsible for determining whether grievances require track and trend analysis or direct provider outreach. When outreach is necessary, you will conduct it efficiently and prepare comprehensive monthly reporting on grievance status and resolutions. This proactive approach helps maintain strong relationships with our providers and ensures member satisfaction.
• • You will also provide essential support for contracting efforts aimed at maintaining and expanding network adequacy. This includes processing contracts, which involves obtaining necessary signatures, preparing accurate provider rosters, and submitting contract load forms to ensure providers are correctly onboarded and reflected in our systems. Your diligence in this area directly impacts our ability to serve members effectively.
• • Assistance with Field Network cases is another key responsibility. You will conduct outreach to providers to gather information, document resolutions, and ensure that all network-related issues are addressed promptly and professionally. This requires excellent communication and problem-solving skills.
• • Furthermore, you will evaluate incoming participation requests, assessing them against critical criteria such as network need, existing contractual relationships, expansion strategies, and overall access to care. Based on your evaluation, you will make informed recommendations to management and, where appropriate, proceed with contracting. You will also respond to provider inquiries and requests in a timely and professional manner.
• • Finally, you will collaborate closely with network managers to prepare for monthly Joint Operations Committee (JOC) meetings. This involves researching outliers in financial reports, auditing reports for accuracy, and assisting with the follow-up actions identified during these meetings. Your contribution will ensure that these critical meetings are productive and that action items are effectively managed.
• • This role offers a unique opportunity to contribute to a mission-driven organization dedicated to improving healthcare for older Americans. You will be part of a fast-paced environment where your analytical skills and dedication to operational excellence will make a tangible impact on our provider network and, ultimately, on the care our members receive.