Customer Support Specialist
Network adequacy and contracting is critical to ensuring members have access to high quality care, and that our products are regulatorily compliant to be sold in the marketplace. This role will be responsible for supporting the organization to achieve network adequacy, member experience and provider goals - in both new and existing markets - by directly engaging with and contracting with providers. Additionally, team members will have the opportunity to build relationships with key providers in the market, and will triage and problem solve issues as they arise.
Primary Duties and Responsibilities
-Understand and know the provider landscape for the assigned market (eg. know providers in and out of network, know the network gaps, including provider groups that are missing and potential additional groups for recruitment, etc)
-Develop familiarity with P&L’s contracting guardrails and workflows, including key terms and rate structures for our provider agreements
-Support the P/L team to close the contracting needed to complete a network construction plan
-Close network gaps (member experience, provider experience and regulatory) and single case agreements by identifying, sourcing, and contracting with providers in a region
-Be a resource for the P/L team to support provider relationships
-Develop familiarity with core provider operational workflows and tools (basic claims escalations, fee schedule request, updated roster information, provider portal set up and maintenance, ACH/EFT set up, etc.) and be able to identify & flag trends for escalation.
-Document and share provider feedback, objections and questions to support the continuous improvement of our contracting templates and processes.
-Support the P/L team on additional network improvement initiatives as identified
Required education and experience
-Bachelors or associate degree, or 1+ years healthcare or healthcare related field
-Familiarity with Word, Excel, and Powerpoint (or Google suite equivalent)
-Strong written and verbal communication skills
-Strong organizational and follow-through capabilities
Preferred education and experience
-Experience in a customer support/customer service role
-Experience negotiating