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Remote Provider Network Development information

What are the key skills and qualifications needed to thrive as a Remote Provider Network Development professional, and why are they important?

To excel in Remote Provider Network Development, you need expertise in healthcare network management, contract negotiation, and provider relations, often supported by a bachelor’s degree in healthcare administration or a related field. Familiarity with health plan software, CRM tools, and knowledge of regulatory compliance systems are typically required. Strong communication, relationship-building, and problem-solving skills are essential for establishing and maintaining provider partnerships. These skills ensure effective network expansion, regulatory compliance, and high-quality service for health plan members.

What are some common challenges faced by professionals in Remote Provider Network Development roles and how can they be addressed?

One of the main challenges in Remote Provider Network Development is building strong relationships with providers and stakeholders without regular face-to-face interaction. This requires effective virtual communication skills and the ability to leverage digital collaboration tools. Additionally, navigating differing regulations and provider expectations across regions can be complex, so staying organized and informed about local requirements is crucial. Proactively scheduling regular check-ins and utilizing centralized documentation can help maintain alignment and foster trust among network partners.

What is a Remote Provider Network Development specialist?

A Remote Provider Network Development specialist is responsible for identifying, recruiting, and managing healthcare providers to join a health plan’s network, all while working remotely. They negotiate contracts, ensure providers meet quality standards, and maintain strong relationships to ensure network adequacy. This role often involves analyzing data to identify network gaps and collaborating with internal teams to address member needs. Remote work allows these specialists to connect with providers across various regions without needing to be on-site.

What is the difference between Remote Provider Network Development vs Remote Provider Relations Specialist?

AspectRemote Provider Network DevelopmentRemote Provider Relations Specialist
Primary FocusBuilding and expanding provider networks, negotiating contractsManaging existing provider relationships, resolving issues
Required CredentialsHealthcare administration, insurance, or related certificationsCustomer service, healthcare administration certifications
Work EnvironmentStrategic planning, cross-department collaborationProvider communication, issue resolution
Industry UsageHealth insurance companies, managed care organizations

Remote Provider Network Development focuses on expanding and negotiating provider networks, while Remote Provider Relations Specialists manage ongoing provider relationships and address issues. Both roles require healthcare or insurance knowledge but differ in their strategic versus operational focus.

What are the most commonly searched types of Provider Network Development jobs in Florida? The most popular types of Provider Network Development jobs in Florida are:
What are popular job titles related to Remote Provider Network Development jobs in Florida? For Remote Provider Network Development jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Remote Provider Network Development jobs in Florida look for? The top searched job categories for Remote Provider Network Development jobs in Florida are:
What cities in Florida are hiring for Remote Provider Network Development jobs? Cities in Florida with the most Remote Provider Network Development job openings:
Remote Provider Network Development jobs near you
(Remote) Provider Contracting & Credentialing Coordinator

(Remote) Provider Contracting & Credentialing Coordinator

The Recovery Village

Weston, FL • Remote

$21/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 9 days ago

Job description

(Remote) Provider Contracting and Credentialing Coordinator

Mental Health & Addiction Field

*Must live in the US in EST and reside in the Eastern (ET)or Central Time (CT) Zone

Hours: 8:00am to 5:00pm ET

Pay Starts: $21+/hr

Advanced Recovery Systems is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse, and mental health issues.  We put behavioral health front and center, providing assistance to people with substance abuse issues, addictions and mental health concerns.

With facilities in various regions of the U.S., we have been furthering this mission since our inception, applying our advanced approach to patient care.

Every facility in the Advanced Recovery Systems network strives to provide the highest quality of care, using evidence-based therapeutic models that really work. Our goal is to help men, women and adolescents live healthy, happy lives without the burden of substance abuse or mental illness.

Benefits include:

  • Health, Vision, Dental, Employer Matched 401(k)
  • STD, LTD, and Employer Paid Term Life Policy - up to $50k
  • Employer Matched HSA - up to $1500 a year company contribution
  • Employee Wellness Program - reduce employee premiums $40/mo
  • Free MDLive telehealth benefit
  • Paid Time Off - Vacation/Personal/Holiday/Sick
  • Employee Referral Bonus 

The Provider Contracting and Credentialing Subject Matter Expert (SME) is responsible for assisting the organization with payer contracting efforts, including but not limited to; provider applications, contract analysis, negotiations, credentialing of facilities and medical/clinical providers. This position ensures the contracting and credentialing department works successfully with multiple departments including Sales/Marketing, Finance, Legal, Compliance, Medical and Operations.

CORE JOB DUTIES:

  1. Ensures that all medical and clinical staff are appropriately credentialed with all payers, and payer requirements.
  2. Assists the credential manager in identifying new hire needs to ensure appropriate credentials are inline with payer needs.
  3. Reviews and prepares payer credentialing applications and recredential application for completeness and accuracy.
  4. Works with providers and credentialing department to ensure required information is available to complete processes.
  5. Works in tandem with ARS Teams (Business Development, Marketing and Finance) to identify opportunities for company growth in terms of managed care contracts.
  6. Evaluates and analyzes contract proposals and works with SVP to negotiate best possible contract rates for ARS.
  7. Direct contact and liaison between payers and ARS facilities as it relates to contracts, addendums, and credentialing needs.
  8. Conduct quality control audits of files and take necessary actions to remediate and prevent future errors.
  9. Prepare reports for internal and external use.
  10. Works with billing department to address non-participation or dis-enrolled providers.

Requirements

QUALIFICATIONS:

  • Minimum of High School Diploma or Equivalent; Bachelor's Degree Preferred.
  • Minimum three (3) years' experience in provider or payer contracting and credentialing.
  • Knowledge of Hospital and/or Behavioral Contracting and Reimbursement.
  • CAQH requirements and profiles, credentialing and re-credentialing applications for facilities and payer contracting.
  • Strong Computer Knowledge.
  • This role requires the employee to utilize their own personal computer, meeting expectations of the company's software and virus security standards.
    • Windows 11 w/ latest Windows update installed. (Chromebooks and Apple computers are not compatible.)
    • an "up to date" antivirus software.
    • Workining camera and microphone 
    • ARS does offer some reimbursement for remote office equipment. 

Advanced Recovery Systems, a national integrated behavior healthcare management company dedicated to the treatment of addiction, substance abuse,  and mental health issues.  

We invite you to learn more about us at our website! 

The Company complies with state and federal nondiscrimination laws and policies that prohibit discrimination based on age, color, disability, national origin, race, religion, or sex. It is unlawful to retaliate against individuals or groups based on the basis of their participation in a complaint of discrimination or on the basis of their opposition to discriminatory practices/EEO.

We are proud to be a drug-free workplace.

Benefits

We offer great benefits including 401(k), paid time off plan, medical, dental, vision, and much more.

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