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Network Operations Representative II in Coral Gables, FL at Beacon Health Options

Date Posted: 4/27/2019

Job Snapshot

Job Description

ABOUT THE POSITION

Serves as the primary liaison between the Network Development department and Clinical, Claims, and Member Services to address benefit and rates inquiries as they relate to contractual or regulatory requirements.  Submit all contractual/regulatory transactional system update requests to Provider Data.    In addition, assist with Network Development department’s contractual rate update and implementation process.

Position Responsibilities:

  • Review 100% of inquires received via Network Department’s Service Connect queue.  This queue is utilize by Claims, Member Services, and Clinical Services to address all authorization and claims issues related to provider loading in Beacon’s transactional system.    
  • Determine if rate and/or benefit update request is supported by contractual or regulatory requirements 
  • Complete all sanction and license verification applicable to out of network providers as it relates to these inquires
  • Submit system update request to Provider Data department along with supporting documentation
  • Assist contractors with rate review and updates both regulatory and contractual & submit request to Provider Data for processing
  • Communicate effectively in writing
  • Will multi-task effectively, including the ability to change priorities and handle ad hoc projects, as needed.

Position Requirements:

Education: High School Diploma or equivalent

Relevant Work Experience:

  • 2 years of managed care contracting experience
  • Strong knowledge of behavioral health transactional systems functions 
  • Attention to detail is a must; position requires loading of rates; maintenance of databases; and other tasks that interact with other departments’ functions such as authorizations and claims payment
  • Well-organized and able to manage workload that will often include tight timelines
  • Strong interpersonal skills, with the ability to be a team player

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.