Provider Network Relations Consultant TN & OH
Description
COMPANY OVERVIEW
Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.
Position Overview
The Provider Network Relations Consultant is responsible for negotiating contracts, developing, and maintaining a cooperative relationship and an excellent rapport with all network providers for an assigned region. The Provider Network Relations Consultant acts as a liaison between the network providers and Zing Health, monitoring providers to ensure access standards are met, promoting strategic initiatives and providing training for all lines of business to ensure that network providers have updated policy and procedure information.
Essential Position Responsibilites
Manages Provider Network by developing and maintaining relationships to drive business results within a specific geographic area.
Conducts Provider Orientations and ongoing education to office staff on Zing Health Policy & Procedures.
Ensures contract SLAs are met, such as meeting with PCPs and Specialists on a monthly, quarterly, or annual basis to address contractual issues, utilization, claims reporting
Daily interface with providers and internal constituents to effectively resolve service issues (contract inquires, claim issues, authorization request, provider access) in a timely manner.
Maintains provider data integrity including monitoring provider credentialing, location additions, demographic updates, and terminations.
Monitors and supports providers using utilization reports, pharmacy profiles, ER contingencies, and other analytics
Understands and explains fee-for-service and risk contracts.
Performs special projects as assigned.
Requirements
POSITION QUALIFICATIONS
Education/Experience
Required Qualifications
Required 3 - 5 years of experience in Provider Relations, Network Development, Network Management, Contracting or related Provider Services position with demonstrated ability to perform the level of duties of the position
Other previous contracting experience preferred
Demonstrated negotiation, analytic and organizational skills
Medicare experience preferred
Required Managed Care experience
Knowledge of healthcare delivery a plus
Microsoft Office Suite experience Word, Excel, and Outlook
Excellent written and interpersonal verbal communication skills
Ability to present in group settings, multi-task, work independently, and work within tight timeframes and meet strict deadlines
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