Internal Provider Relations Representative

Company Overview: Health Network One partners with health plans and providers to modernize how specialty care is delivered and managed, reducing complexity, driving better performance, and improving lives.

With over 30 years of experience, Health Network One advances care in several unique specialties: eye care, skin health, outpatient therapy, and more. By curating specialty networks and credentialing providers who meet rigorous access and quality standards, we bring together value-based models and clinical expertise to ensure providers thrive, payers succeed, and members receive the high-quality care they deserve.

Position Summary: Interacts with and discusses contract and credentialing with physicians, specialists, ancillary providers and hospitals.

Key Responsibilities:

• Target and/or follow-up with potential providers to establish contractual agreements.
• Interacts with providers regarding all contract matters for HN1 including any necessary
• (i.e. credentialing, applications, W-9, PIP, etc)
• Recruits and contracts physicians, specialists, ancillary providers and hospitals for HN1.
• Responds to provider inquiries regarding contract matters, provider networks issues and HN1
• Works with contracted providers to help integrate their services into the overall care delivery
• Researches and solves any questions or concerns that providers, external provider
• representatives, Health Plans and other internal departments, may have
• Analyzes, prepares, maintains and distributes various departmental reports, including
• specialized reports for providers or networks; HN1 quarterly provider bulletins; various
• presentations and custom reports requested by Senior Management.
• Organize, develop and execute provider outreach projects.
• Maintain lines of communications with all internal departments and with all participating
• providers in enlisting their assistance in referring potential providers in the Network.
• Ensures compliance with and/or adheres to company HIPAA policies and procedures.
• Ensures integrity of data entered into company systems and databases.
• Manage the normal office activities for the Network Department to include but not limited to:
  • Maintains and updates physician files.
  • Composes and types routine correspondences
  • Reads and routes incoming mail and prepares outgoing mail and correspondences, including emails and faxes.
  • Answers and screens departmental telephone calls, and arranges conference calls.
  • Coordinates department’s schedule and schedules appointments
  • Coordinates and arranges meetings, prepares agendas, reserves and prepares facilities, and records and transcribes minutes of meetings.
• Support other departments as needed.
• Supports Credentialing Department by assisting with the collection of physician credentials for
• re-credentialing purposes.
• Evaluates claim data on recently contracted providers, ensuring contract is profitable for
• Other Duties as assigned

Required Qualifications:

High school diploma or equivalent. Previous health care experience

Preferred Qualifications:

• Bilingual-Spanish
• Knowledge of physician office procedures
• Knowledge of medical terminology, CPT coding, billing procedures

 Location/Travel: Remote, no travel