Network Specialist Job in Wall, New Jersey US
Job Summary
This position is accountable for physician outreach, relationship management, issue identification and resolution, and problem avoidance. This is achieved by serving as the primary member of a team made up of people from various functional areas in the end-to-end provider experience process and is responsible to support the team for the benefit of the providers assigned to the pod/team. This includes maintaining effective relationships with all facets of the physician community, including physician education, facilitation and resolution of complex, urgent problems and data integrity maintenance. This position will identify opportunities for savings, utilizing tools such as claims paid reports, utilization management reports, physician profiling data and referral pattern data. This position is responsible to work directly with network physicians to identify referral alternatives, to provide education, and to track cost savings outcomes.
Job Qualifications
Education/Experience:
- Prefers a Bachelor's degree in business, marketing, communications, healthcare administration or other related field.
- Requires a minimum of five (5) years healthcare experience, preferably with provider or client focus/interaction.
- Prefers marketing or sales experience in the healthcare/insurance industry.
Knowledge:
- Requires knowledge of healthcare industry.
- Requires knowledge of New Jersey physician community.
- Prefers knowledge of HBCBSNJ programs, products and procedures.
- Requires strong PC skills including Microsoft Office and Lotus Notes.
Travel (If Applicable)
Occasional travel throughout the state of NJ may be required.