Provider Network Specialist jobs in the United States

Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers’ comp, we strive to provide an atmosphere of constant growth and development for our employees.

Summit provides workers’ compensation programs and services to thousands of employers throughout the Southeast.

Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it’s underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise.

It’s one thing to know workers’ comp. It’s another to know people. But knowing both? That creates an altogether different experience.

So, if you’re ready for an altogether different workplace experience, get to know the people who know workers’ comp. Apply today.

Essential Job Functions and Responsibilities

• Recruits and contracts with physicians to be part of a provider network.
  • Negotiates terms and reimbursement rates on routine to complex contracts.
  • Evaluates physician retention within the network and determines recruiting needs to maintain an approved network.
  • Identifies education needs and trains network providers.
  • Contacts out-of-network specialists to negotiate arrangements to provide services to a claimant with a unique injury.
• Prepares moderately complex to complex contractual provisions.
  • Negotiates amendments, contract language, and/or terms as necessary.
  • Functions as an intermediary between providers and Corporate Legal.
  • Supports staff in preparing and verifying contracts and associated language and paperwork for complex contract packages.
  • Participates in developing contract language to meet business, regulatory, and legal requirements.
  • Researches and advises Credentialing Committee of potential legal and financial risks of contracts.
  • May make recommendations on contract changes.
• Analyzes accuracy, timeliness, and quality of work to recommend improvements to processes and procedures.
• Responsible for the assessment of the networks and providers within the network. Responsible for accurate and complete audit of provider files. Responsible for creating, maintaining, and updating information on contracted physicians within the network.
  • Verifies and maintains accurate data on network providers which may include updates to name, address, payment information, credentialing information, etc.
• Prepares and evaluates contract and credential reports to ensure compliance.
• Processes renewal contracts and/or terminations.
• Researches and resolves questions (telephone, email, correspondence, etc.) from physicians regarding issues with bills and payments.
• May participate in determining customer satisfaction with services or products
• Serves as liaison with network providers, claims staff, Corporate Legal, and managed care staff to resolve provider concerns and issues.
• Applies advanced knowledge of department policies and procedures and utilizes broad understanding of the business and organization.
• May lead the work of others. Provides guidance, technical advice, training, and assistance to lower-level positions and other functional areas.
• Performs other duties as assigned.

• The person hired for this position will work out of the Lakeland, FL office which offers a hybrid work environment of 3 days in the office and 2 days' work from home.

#LI-Hybrid

Job Requirements

Education: Associate Degree or equivalent experience.

Field of Study: Business Administration or related discipline.

Experience: Generally, 5 or more years related experience.

Company:

Benefits:

Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.

We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.

Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.