Provider Network Operations Consultant

Published
September 27, 2020
Location
Dallas, TX
Category
Job Type

Description

Mitchell, Genex and Coventry

With Mitchell, Genex and Coventry now one organization, we’ve dramatically expanded our ability to deliver innovative services and technologies to our customers. We’ve also seen career opportunities within our combined organization grow. Each part of our organization helps people recover after a challenging event in their lives.

 

Mitchell delivers trusted software and services to the property & casualty claims, collision repair and risk management industries with technology-enabled solutions that simplify claims handling, repair processes and pharmacy transactions. Genex helps injured workers return to their jobs in a safe and efficient manner through compassionate case management, reducing health care costs and disability expenses for our customers. Coventry offers the nation’s largest and most diverse set of provider and ancillary networks focused on improving total overall outcomes.

Together, we bring a complete set of proven capabilities for our partners who require more than one-dimensional solutions. We combine innovative technology, insightful analytics and deep expertise to help them reach their ultimate goal—restoring lives.

Job Description

Responsible for supporting provider network development, maintenance, and optimization by performing research analysis, reviewing contract documents, facilitating credentialing and provider system set up, and collaborating on negotiations.

  • Performs post-signature review of incoming contracts and supporting documentation.
  • Reviews provider contracts to determine appropriate rate and system set up requirements.
  • Facilitates rate and provider system set up, monitors progress and audits set up.
  • Submits providers into Credentialing process and monitors outcomes.
  • Conducts research to support contract negotiations.
  • Interacts with providers to obtain credentialing documents and roster information.
  • Updates activity in tracking systems (databases, provider data systems and routing systems.)
  • Accountable for quality and turnaround time metrics.
  • Performs project work in support of business initiatives.
  • May assist with contract template drafting and maintenance.
  • May assist with recruitment of providers and provider education.

*This is a remote position.

Qualifications

  • Undergraduate degree or equivalent work experience.
  • 3+ years of provider network and provider data system experience.
  • Strong communication, critical thinking, problem resolution and interpersonal skills.
  • Proven working knowledge of standard provider contracts, terms, language, and rates.
  • Proficiency with MS Office applications. (Word, Excel, QuickBase, PowerPoint, Outlook.)

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