Network Development Support Specialist
Chicago, IL

Job Description

Overview

Who we are:

Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.



We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.

Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

A Day in the Life of a Network Development Support Specialist:

This position works collaboratively with other members of the Network Development team to assist with provider follow up and administrative support related to all Network Development functions. This position specifically supports the contracting process and providing excellent customer service to our provider network. The position will be assigned one or more Provider Network Development Representative(s) (PNDR(s)) to work with and support their assigned territory.

Responsibilities

* Assist PNDR's with change forms and top sheets when needed to update Provider changes and or additions in MCS (complete and submit appropriate documentation for proper set up in MCS)
* Coordinate provider claims inquiries, grievances & appeals, and general issue resolution
* Help coordinate and track provider training (Cultural Competency, Model of Care, FWA, Provider Portal, and others to be determined)
* Working with Corporate Provider Services on missing/incomplete provider credentialing information
* Educating assigned providers on MHP's provider policies and procedures as necessary
* Special projects related to provider development and education
* Assist PNDR's in prospecting to potential providers for inclusion in the MHP Provider Network telephonically
* Provide exceptional customer service to our Provider Network
* Assist with reporting requirements
* Oversight of the provider help inbox
* Conduct provider audits for demographic information
* Perform other duties as assigned

Qualifications

What you can bring to Meridian:

* High school diploma is required
* Bachelor's degree or Fellow designation from the Academy for Healthcare Management (AHM) is required
* One year of provider services or managed care experience is preferred
* Basic knowledge of MHP's philosophy, organizational structure and plan overview
* Basic knowledge of MHP's practitioner, hospital and ancillary agreements
* Basic knowledge of MHP's credentialing requirements for all providers
* Basic knowledge of managed care reimbursement methods
* Thorough knowledge of CMC's mission and its operational structure
* Thorough knowledge of managed health care industry
* Knowledge of MHP's provider manual, including policies and procedure
* Computer skills, including working knowledge of Excel and Oracle software
* Follow up skills, with a "do whatever it takes" attitude
* Strong organizational skills
* Strong writing and presentation skills
* Ability to communicate clearly and concisely both orally and via written documents
* Ability to work as part of a team while maintaining and exceeding individual goals and objectives
* Self-motivation and outstanding ability to sell

What Meridian can offer you:

* Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
* Opportunity to work with the industry's leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
* Meridian offers 401k matching that is above the national average.
* Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor's or Master's degrees.
* Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.

Equal Opportunity Employer

#MSTR