Network Relations I
Waukesha, WI · Remote
$16.74 - $26.92/hr
... payor relations and product development * Conduct and manage provider data audits that ensure data ... Remote
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Network Relations I
Waukesha, WI · Remote
$16.74 - $26.92/hr
... payor relations and product development * Conduct and manage provider data audits that ensure data ... Remote
Network Relations I
Waukesha, WI · Remote
$16.74 - $26.92/hr
... payor relations and product development * Conduct and manage provider data audits that ensure data ... Remote
Network Relations I
Waukesha, WI · Remote
$16.74 - $26.92/hr
... payor relations and product development * Conduct and manage provider data audits that ensure data ... Remote
Remote Payor Relations information
What is a remote payor relations specialist?
Remote Payor Relations professionals manage the relationships between healthcare providers and insurance payors from a remote location. Their primary responsibilities include negotiating contracts, resolving billing issues, ensuring compliance with regulations, and facilitating communication between providers and insurance companies. Working remotely, they leverage digital tools to handle documentation, meetings, and data analysis, helping organizations maximize reimbursements while maintaining positive partnerships with payors.
What are the key skills and qualifications needed to thrive as a remote payor relations specialist?
To thrive as a Remote Payor Relations Specialist, you need a strong understanding of healthcare reimbursement, contract negotiation, and insurance regulations, often supported by a bachelor's degree in healthcare administration or a related field. Familiarity with payer portals, claims management systems, and contract management software is typically required. Excellent communication, problem-solving, and relationship-building skills help you navigate complex issues with payers and internal teams. These capabilities are essential to securing favorable contracts, resolving claim disputes, and ensuring financial stability for healthcare organizations.
What are the most common challenges faced by professionals in remote payor relations roles, and how can they be effectively managed?
Professionals in Remote Payor Relations often encounter challenges such as navigating complex insurance policies, staying updated with frequently changing payor requirements, and fostering effective communication across virtual teams. Managing these challenges involves maintaining organized documentation, leveraging digital tools to track payor updates, and proactively collaborating with internal departments like billing and compliance. Developing strong relationships with payors and participating in ongoing training also help ensure smoother negotiations and issue resolution.
What is the difference between Remote Payor Relations vs Remote Claims Specialist?
| Aspect | Remote Payor Relations | Remote Claims Specialist |
|---|---|---|
| Credentials | Healthcare experience, insurance knowledge, communication skills | Medical coding, billing certifications, attention to detail |
| Work Environment | Office or remote, interacting with payers and providers | Remote, processing and reviewing claims |
| Employer & Industry | Healthcare insurers, providers, third-party administrators | Hospitals, clinics, insurance companies |
| Search & Comparison Intent | Understanding payer relations, insurance negotiations | Claims processing, billing, reimbursement issues |
Remote Payor Relations roles focus on managing relationships with insurance payers, negotiating coverage, and ensuring smooth communication. Remote Claims Specialists handle claims processing, billing, and reimbursement tasks. While both roles operate within the healthcare insurance industry and may require similar healthcare knowledge, their core responsibilities differ—one emphasizes payer relations, the other claims management.
What are the most commonly searched types of Payor Relations jobs in Wisconsin?
The most popular types of Payor Relations jobs in Wisconsin are:
What are popular job titles related to Remote Payor Relations jobs in Wisconsin?
For Remote Payor Relations jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Remote Payor Relations jobs in Wisconsin look for?
The top searched job categories for Remote Payor Relations jobs in Wisconsin are:
Network Relations I
Waukesha, WI • Remote
CorVel Healthcare Corporation
$16.74 - $26.92/hr
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 14 days ago
Job description
The Network Relations role supports the frontline of Network Development, responsible for providing excellent customer service while impacting and overseeing provider data integrity. This role must combine strong interpersonal skills with an aptitude in the medical provider market.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
- Assist Developer with implementing medical providers, using written and verbal communication
- Verify all provider signatures, contracts and documentation after submitting for internal processing
- Review credentials of prospective providers to be considered for acceptance into network per national credentialing requirements and protocols
- Provide orientation on managed care procedures and establish liaison(s) with all participating providers
- Assist and communicate with provider orientation program in cooperation with Developer
- Distribute and maintain provider manual and orientation materials per state guidelines
- Receive and resolve all disputes involving provider contract and payment issues in accordance with contract Dispute Resolution Procedures
- Provide assistance and respond to staff requests for information regarding the network, both locally and nationally
- Oversee distribution of executed contracts and maintenance of database
- Assist with network marketing, employer and payor relations and product development
- Conduct and manage provider data audits that ensure data integrity for network and oversee all provider updates and changes with NDB
- Coordinate and process provider roster updates at least annually or as otherwise required
- Perform facility site surveys as needed per credentialing requirements or state guidelines
- Identify specialties within network and generate a recruitment list for Developer
- Additional duties as assigned
KNOWLEDGE & SKILLS:
- Strong interpersonal skills and adaptive communication style
- Complex problem solving skills and innovation
- Ability to quickly adapt to process changes
- Ability to prioritize and manage assignments, scheduled or unscheduled
- Ability to embrace new tools and procedures per corporate guidelines and objectives
- Strong organizational skills
- Excellent written and verbal communication skills
- Superb attention to detail and ability to deliver results in a fast paced and dynamic environment
- Proficient in Microsoft Office applications
EDUCATION & EXPERIENCE:
- Associate’s degree or two or more years of equivalent work experience
- Customer service education/training within the insurance industry, managed care or related field
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $16.74 - $26.92 per hour
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL:
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
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