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In-House Network Representative (Centrum Health)

Bright Health

Bright Health

Doral, FL, USA
Posted on Friday, February 10, 2023

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Our mission is to make healthcare right. Together. We are a value-driven healthcare company committed to providing personalized care to aging and underserved populations. We do this by aligning stakeholders across the healthcare ecosystem. Together, we can improve consumer experience, optimize clinical outcomes, and reduce total cost of care.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.

Job Summary:

Centrum Health, a part of NeueHealth, , is seeking an in-house network management representatives to provide support to the network management unit from an in-house perspective. The in-house rep will serve as a liaison between the provider network and the management team at our corporate office.

Duties and Responsibilities

  • Initiating and maintaining effective channels of communication with service providers and clients.
  • Gathering, reviewing, and verifying all pertinent information relating to participating healthcare providers.
  • Establishing and maintaining relationships with assigned healthcare providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service.
  • Conducting training of service providers on policies, procedures, service lines, and available technology.
  • Answering questions from doctors' offices on benefits.
  • Gathering, reviewing, and submitting relevant documentation needed for claims processing.
  • Managing healthcare provider accounts to achieve company strategies and goals.
  • Maintaining a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare.
  • Assisting help desk staff with more complicated benefit queries received.
  • Identifying shortfalls in healthcare provision and initiating improvement opportunities.

Requirements and Qualifications:

  • A bachelor's degree in healthcare administration or equivalent.
  • A minimum of 2 years experience in client services, provider relations, and claims processing.
  • Knowledge and understanding of claims processes and data capturing.
  • Proficiency in creating presentations, training documents, reports, and analytical graphs.
  • Proficiency in MS Outlook, Excel, and Word.
  • Ability to work independently.
  • Excellent verbal and written communication skills.
  • Good problem-solving skills.
  • Must be bilingual (English & Spanish)
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.