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Network Management Representative
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Full-time
- This includes, but is not limited to, contracting and on-boarding to ensure that there are no unnecessary delays in the process.
- Applying problem-solving techniques as it relates to dispute resolution to include, but not limited to, HMSA's provider contract definition, application of payment or medical policies, provider operations that involve posting claims payments, and complaints made through the Insurance Commissioner's office within timeframes required by the Insurance Division or by HMSA as stated in the provider contract.
- Conducts proactive and requested field visits to provider's offices to gain market intelligence, support, drive behavior change, and provide guidance on HMSA business initiatives including, but not limited to, changes in claims processing, reimbursement, policies, promotion of self-service tools, and support of various complex HMSA programs.
- Participates and attends Community or Provider sponsored events representing HMSA in support of a viable, accessible provider network.
- Coordinate and conduct education activities involving providers, Provider Services and other HMSA departments with the objective to modify inefficient claim filing behaviors and to implement operational business changes.
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