Maintains relationships with physicians, hospitals, ancillary providers and Health Net's internal Provider Network Management Dept
Job Summary
Maintains relationships with physicians, hospitals, ancillary providers and Health Net's internal Provider Network Management Dept.
Researches, analyzes and resolves complex problems with claims development and finalization.
Prepares monthly reports to management to document issues, action plans, and resolutions of quality initiatives and provider relation improvement initiatives.
Matching Summary
Maintains relationships with physicians, hospitals, ancillary providers and Health Net's internal Provider Network Management Dept.
Salary
Base: $56,200.00 - $101,000.00 per year; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package
Skills & Requirements
Must-have
claims development and finalization
provider relationship management
policy and procedure interpretation
root cause analysis
corrective action plans
Nice-to-have
community health transformation
workplace flexibility
process improvement initiatives
Key Requirements
Bachelor's degree or equivalent experience
Minimum of two years experience in medical claims review/appeal