Provider Relations Specialist Indiana - Remote
Job description
About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan, Indiana and Ohio. The McLaren system includes 14 hospitals in Michigan and Ohio, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 51 National Cancer Institute-designated comprehensive cancer centers in the U.S.
MDwise is your local, Indiana-based nonprofit health care company. We were founded in 1994 to help vulnerable populations needing health coverage in Indiana. Our parent organization, McLaren Health Care, is a nonprofit integrated health system who believes all Indiana families should have access to high quality health care regardless of income. Our mission is to provide high quality health care. MDwise works with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.
MDwise is seeking the right individual to join our team in our (add in the correct name such as Customer Service, Medical Management, etc so candidates understand) department. As an employee of MDwise, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
Position Summary:
The Provider Relations Specialist is responsible for all aspects of provider enrollment, including maintaining and validating provider demographics, open acceptance status, and directory accuracy. Collaborates with department Leadership to develop and implement processes to monitor contractual obligations and ensure the Plan’s compliance with such. Supports all contracting activities of the Provider Relations Team, including required follow up with such groups to facilitate obtaining provider demographic information required by the Plan, ensuring documentation is accurately completed for entry onto the Plan’s claim system, issuing contract reminders, ensuring contracts are returned and filed, etc. Identifies process improvement opportunities and develops plans to address opportunities.
Learn more about MDwise, Inc. at https://www.mdwise.org/.
This position is a fully remote position.
Qualifications:
Required:
- High School Diploma or equivalent (GED).
- Two (2) years’ experience and knowledge of HMO, PPO, TPA, and Managed Care functions.
Preferred:
- Associate degree in business, health care or related field.
- Schedule: Full-time
- Requisition ID: 23000905
- Daily Work Times: Variable
- Hours Per Pay Period: 72
- On Call: No
- Weekends: No
Per Centers for Medicare & Medicaid Services (CMS) regulations, all McLaren employees must be vaccinated for COVID-19 by January 4, 2022. The regulation permits exemptions for employees with qualified medical disabilities or religious beliefs.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
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