Provider Relations Specialist, MI - Remote

We are looking for a Provider Relations Specialist to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG,you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.Learn more about MDwise, Inc. at https://www.mdwise.org/

Position Summary:

Responsible for all aspects of provider enrollment, including maintaining and validating provider demographics, open acceptance status, and directory accuracy.Collaborates with department Leadership to develop and implement processes to monitor contractual obligations and ensure the Plan’s compliance with such.Supports all contracting activities of the Provider Relations Team, including required follow up with such groups to facilitate obtaining provider demographic information required by the Plan, ensuring documentation is accurately completed for entry onto the Plan’s claim system, issuing contract reminders, ensuring contracts are returned and filed, etc.Identifies process improvement opportunities and develops plans to address opportunities.

This position is fully remote.

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Qualifications:

Required:

• High School Diploma or equivalent (GED).
• Two (2) years’ experience and knowledge of HMO, PPO, TPA, and Managed Care functions.
  
  

Preferred:

• Associate degree in business, health care or related field.
• Two (2) years healthcare claims and/or billing experience with basic understanding of payment methodology and medical terminology.
  
  

Additional Information

• Schedule: Full-time
• Requisition ID: 24007181
• Daily Work Times: 8:00 am - 5:00 pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No