Job Summary:

Centrum Health, a part of NeueHealth, , is seeking an in-house network management representatives to provide support to the network management unit from an in-house perspective. The in-house rep will serve as a liaison between the provider network and the management team at our corporate office.

Duties and Responsibilities 

• Initiating and maintaining effective channels of communication with service providers and clients.
• Gathering, reviewing, and verifying all pertinent information relating to participating healthcare providers.
• Establishing and maintaining relationships with assigned healthcare providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service.
• Conducting training of service providers on policies, procedures, service lines, and available technology.
• Answering questions from doctors’ offices on benefits.
• Gathering, reviewing, and submitting relevant documentation needed for claims processing.
• Managing healthcare provider accounts to achieve company strategies and goals.
• Maintaining a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare.
• Assisting help desk staff with more complicated benefit queries received.
• Identifying shortfalls in healthcare provision and initiating improvement opportunities.

Requirements and Qualifications: 

• A bachelor’s degree in healthcare administration or equivalent.
• A minimum of 2 years experience in client services, provider relations, and claims processing.
• Knowledge and understanding of claims processes and data capturing.
• Proficiency in creating presentations, training documents, reports, and analytical graphs.
• Proficiency in MS Outlook, Excel, and Word.
• Ability to work independently.
• Excellent verbal and written communication skills.
• Good problem-solving skills.
• Must be bilingual (English & Spanish)