Meridian Health Plan Network Development Support Specialist in Detroit, Michigan

Overview:

Who we are:

Meridian is a family-owned, family-operated company of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.

We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in five different states (Michigan, Illinois, Indiana, Kentucky, and Ohio).

Our employees work hard, play hard, and give back. Meridian employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, weekly Executive Lunches, and volunteer opportunities.

A Day in the Life of a Network Development Support Specialist:

This position works collaboratively with other members of the Network Development team to assist with provider follow up and administrative support related to all Network Development functions. This position specifically supports the contracting process and providing excellent customer service to our provider network. The position will be assigned one or more Provider Network Development Representative(s) (PNDR(s)) to work with and support their assigned territory.

Responsibilities:

  • Assist PNDR’s with change forms and top sheets when needed to update Provider changes and or additions in MCS (complete and submit appropriate documentation for proper set up in MCS)

  • Coordinate provider claims inquiries, grievances & appeals, and general issue resolution

  • Help coordinate and track provider training (Cultural Competency, Model of Care, FWA, Provider Portal, and others to be determined)

  • Working with Corporate Provider Services on missing/incomplete provider credentialing information

  • Educating assigned providers on Meridian’s provider policies and procedures as necessary

  • Special projects related to provider development and education

  • Assist PNDR’s in prospecting to potential providers for inclusion in the MHP Provider Network telephonically

  • Provide exceptional customer service to our Provider Network

  • Assist with reporting requirements

  • Oversight of the provider help inbox

  • Conduct provider audits for demographic information

  • Perform other duties as assigned

Qualifications:

What you can bring to Meridian:

  • High school diploma is required

  • Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is required

  • One year of provider services or managed care experience is preferred

  • Basic knowledge of Meridians’s philosophy, organizational structure and plan overview

  • Basic knowledge ofMeridians’s practitioner, hospital and ancillary agreements

  • Basic knowledge ofMeridians’s credentialing requirements for all providers

  • Basic knowledge of managed care reimbursement methods

  • Thorough knowledge of CMC’s mission and its operational structure

  • Thorough knowledge of managed health care industry

  • Knowledge ofMeridians’s provider manual, including policies and procedure

  • Computer skills, including working knowledge of Excel and Oracle software

  • Follow up skills, with a “do whatever it takes” attitude

  • Strong organizational skills

  • Strong writing and presentation skills

  • Ability to communicate clearly and concisely both orally and via written documents

  • Ability to work as part of a team while maintaining and exceeding individual goals and objectives

  • Self-motivation and outstanding ability to sell

What Meridian can offer YOU:

  • Ourhealthcare benefitsinclude a variety of PPO plans that are effective on the first day of employment for our new full-time team members.

  • Meridian offers401k matchingthat is above the national average.

  • Opportunities for growth are abundant; full-time Meridian employees are eligible fortuition reimbursementand all employees have access to a variety of training through Meridian University.

  • Meridian was namedDetroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.

Job ID 2017-4560

Job Location US-MI-Detroit

Category Network Development

Business Line MHP Michigan