Provider Network Specialist - BayCare Health Plans
Job Posting for Provider Network Specialist - BayCare Health Plans at BayCare
At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.
Summary:
The Provider Network Specialist for the Health Plan monitors CMS provider access standards, assists with provider orientation and training, and coordinates with the outsource Vendor and insource Department Leads to resolve provider issues. Responsible for provider network delivery to vendors. Coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Distributes contract information, status updates, and other information within the organization. Collaborates with Compliance for provider directory audits, as needed. Collaborates with Credentialing Team to ensure contracted provider files are routed correctly for approval. Maintains master provider network list for distribution to provider directory vendor and other internal departments, as needed. Assists with Provider Network committees, as needed. Required experience includes 3 years provider relations and Medicare Advantage contracting.
Minimum Qualifications:
Required - 3 years - Reference summary for details; Preferred - 2 years - Data Analytics
Education:
Essential:
- Education Requirements in Comments
Education equivalent experience:
Essential:
- Required - Bachelors - Business; Or - Bachelors - Healthcare Administration
Facility:
BayCare Health System, Tampa Startup-BHS
Location: BayCare System Office West
Status: Full Time, Exempt: Yes
Shift Hours: 8:00 AM - 4:30 PM
Shift: Shift 1
Shift 1 = Days, 2 = Evenings, 3 = Nights, 4 = Varies
Weekend Work: None
On Call: No
Does this position fall under CMS guidelines for COVID19 vaccine or exemption?: Yes - CMS Requirements Apply
How often will this team member be working remotely? Hybrid
Equal Opportunity Employer Veterans/Disabled
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