Provider Network Relations Specialist - Quality

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SCOPE:

The Provider Network Relations Quality Specialist is responsible for the quality of Acuity's worldwide provider network in alignment with Acuity's overall mission, values, and strategic plan. Strong documentation, interpretation, and follow-up are essential activities of this position. Interacts daily with providers’ staff members and Acuity employees and managers internally.

LOCATION:

This position is based in Cape Canaveral, FL.

DUTIES AND RESPONSIBILITIES:

• Review, research, and respond to provider network quality requests submitted through the Provider Information Network System (PINS) ticketing system. Collaborates with program management and medical staff as necessary. 
• Develop training materials and presentations for distribution to provider network facilities and/or providers. 
• Provide guidance and education to provider network staff on component and/or client specific protocol.
• Track provider data issues, progress and status for reporting to management.
• Establish an effective working relationship with provider network administrators and their staff; respond in a timely fashion to their identified concerns.
• Prepare materials for the provider network operations monthly health network forum.
• Assist with the creation of written communications to the network providers, including the weekly email communications regarding new or changing contract requirements.
• Responsible for the distribution and tracking of the provider network facility surveys.
• Ensure ongoing provider network data accuracy through regular reconciliation of the Provider Information Network System (PINS). 
• Responsible for the distribution of exam results received from our network facilities.

REQUIRED QUALIFICATIONS:

• High School diploma with 1-year relevant experience (provider relations, network management, customer service, quality assurance and/or negotiations) required.
• Proven conflict resolution experience required.
• Proficiency with computer and common office equipment, as well as with MS Office products required. 
• Must have excellent oral and written communication skills; strong analytical/problem-solving skills; and excellent attention to detail

PREFERRED QUALIFICATIONS:

• Associate degree with 2 years of relevant experience (provider relations, network management, customer service, quality assurance and/or negotiations) preferred.
• Medical, dental, or healthcare network and/or insurance experience preferred.

PHYSICAL REQUIREMENTS:

• Work is normally performed in a typical interior/office work environment.
• Work involves sitting for prolonged periods of time.
• May require bending, stooping and lifting up to 15 lbs.
   

Acuity International is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, national origin, age, protected veteran status, or disability status.

For OFCCP compliance, the taxable entity associated with this job posting is:

Acuity-CHS, LLC