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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing provider contracts and compliance within the healthcare industry, with strong abilities in training, communication, and project execution. Proficient in analyzing complex contractual agreements and educating network providers on policy changes.
Highest-signal resume keywords
Provider Contract ManagementHealthcare Billing KnowledgeManaged Care ExpertiseContractual AnalysisTraining and Education
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Contractual ComplianceChart AuditsCredentialing ReviewsPolicy InterpretationRegulatory CommunicationHealthcare Insurance KnowledgeMulti-Provider Contract UnderstandingMedical Necessity ResearchProject ExecutionProvider Relations
Soft Skills
Self-StarterOrganizational SkillsMultitaskingCommunication SkillsProblem-Solving
Industry Keywords
Managed Care IndustryCoxHealth ContractsProvider Office ManagementHealthcare Compliance StandardsInsurance Industry Regulations
About the role
Key responsibilities & impact- Assist network providers with contractual issues
- Act as a trainer/educator on CoxHealth Network contracts for network providers and their staff
- Organize and host meetings when required
- Perform initial and recredentialing on-site reviews and chart audits for providers as needed
- Resolve contracts and deliver and interpret policy and procedure changes related to specific contracts
- Communicate regulatory changes related to the insurance industry as needed
- Research new technology related to payors' medical necessity and coverage
- Maintain contacts and provide educational information to network, tertiary/affiliate PHO networks impacting over 3,000 providers/facilities
- Organize, prioritize, and multitask to execute projects and daily workflow
Requirements
What you’ll need- High School Diploma or Equivalent
- 3-5 Years experience working in the provider office, healthcare billing, healthcare insurance and/or Managed Care industry
- Ability to understand complex multi-provider payor contract agreements and determine compliance standards are being adhered to
- Must be a self-starter and work with minimal supervision
- In-depth working knowledge of managed care plans and CoxHealth contracts
- Understanding of the legality of the messenger process used for independent providers
- Ability to analyze and communicate contractual terms and requirements to providers
- Local travel required
- Preferred: Bachelors in a Related Field
- Preferred: Previous experience in provider relations and/or physicians office management
Benefits
Comp & perks- Medical, Vision, Dental
- Retirement with Employer Match
- Benefits eligibility for employees working 20+ hours/week