Provider Network Relations Quality Specialist (PNOPS)

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Job Summary:

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

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.

Qualifications:

• High School diploma with 1year 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/problemsolving 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 and Work Conditions:

• Work is normally performed in a typical interior/office work environment.
• Work involves sitting and standing for prolonged periods of time.

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.

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