Employers Health Network, LLC (EHN ) creates community-based healthcare networks and a unique governance model to form a true partnership between self-funded employers and providers. With a commitment to improving healthcare outcomes while managing costs, we strive to create a healthier and more productive workforce/ Our networks bring together employers and healthcare providers to collaborate and deliver high-quality, high-value care.

Role and Responsibilities

This role will be responsible for claims administration, roster management, and appeal resolution within the Network Operations Department.

• Maintain and review all inbound claims for network and pricing accuracy.

• Implement Quality Assurance measures to ensure contract configuration accuracy.

• Work directly with TPA’s and clients to research and resolve claims and services inquiries.

• Work directly with vendor partners to determine the root cause of pricing inaccuracies and determine resolution.

• Collaborate with Network Development to ensure new provider contract reimbursements are loaded accurately and in a timely fashion.

• Work directly with vendor partners to load, update, and maintain provider rosters.

• Work directly with vendor partners to manage annual fee schedule updates.

• Analyze and identify trends in performance that offer continued efficiency within department.

• Proactively analyze and identified trends in quality results that support our operational goal of continuous process improvement.

• Any other responsibilities assigned by his/her supervisor.

• Abide by all obligations under HIPAA related to Protected Health Information (PHI).

• If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.

• Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.

  Skills and Competencies

• Microsoft Office Suite and advanced MS Excel skills

• Highly self-motivated and directed

• Able to exercise independent judgment and take action on it

• Strong analytical and critical thinking skills and the ability to report findings in a concise and accurate manner

• Ability to effectively prioritize and execute tasks while under pressure

• Work cooperatively with people at all levels with respect and demonstrate the ability to respond appropriately in a variety of complex situations;

• Excellent verbal and written communication and presentation skills

• Problem Solving/Analysis

• Technical Capacity

• Thoroughness

• Time Management

• Attention to Detail

  Position Type and Expected Hours of Work

  This is a full-time, salaried position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m., with occasional after-hours or weekend duties.

  Required Education and Experience

• Understanding of claims processing systems

• 2+ years of healthcare claims processing (PPO and Medicare/RBP)

• Detailed understanding of PPO repricing, provider contract configuration and reimbursement experience

• Familiarity with management of self-funded employer health plans

• Experience in provider network development, including physician and hospital pricing metrics and methodologies

• Strong Microsoft Excel Skills.

  Apply today and be part of a dynamic team dedicated to utilizing data for positive transformations in the healthcare industry.