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Provider Network Specialist

Position Code: 9960

Department:  EIIT
Location: Nashville, Tennessee
Immediate Supervisor:  Virginia Hickman
Status: Exempt
Posted: April 27 2018

Essential Functions of Job:

• Create and maintain provider contracted rates and demographics for both internal and external PPO networks • Interact with Provider Relations and Claim Processing/Repricing Units to research any network discrepancies and/or inquiries • Serve as expert on the interpretation of provider rates for assigned networks • Utilize Microsoft Excel and/or Microsoft Access extensively to format incoming data files based on internal standards • Work with IT to load provider data from external sources • Collaborate with Provider Relations to load, research, and update internal provider network data utilizing Cactus and HealthAxis systems • Participate in new network and/or client implementation process, representing Provider Network Load team on both internal and external calls/meetings, and manage assigned networks through the implementation process and on an ongoing basis as needed (i.e., quarterly, annually) • Other duties as assigned • Ability to report to the office


• Associates or Bachelors Degree preferred, high school diploma or equivalent acceptable with related experience • Advanced organizational and prioritization skills, with meticulous attention to detail • Excellent written and oral communication skills, including giving presentations • In-depth knowledge of Microsoft Office applications (Word, Excel, Outlook, Access) • Ability to work in a fast paced multi-tasking environment • Strong interpersonal skill with ability to function as a positive team member • Ability to quickly grasp new software, experience in computer operations/programming a plus • Logical, analytical approach to understanding of medical, dental, and vision benefits, claims processing, benefit interpretation and PPO network relationships • Ability to read, understand, and interpret facility, ancillary and professional contracts • Knowledge of Cactus provider system and HealthAxis claims system desired • 3+ years’ experience in the healthcare industry preferred


The Company considers applicants without regard to race, color, national origin, sex, religion, mental or physical disability, marital status, age 40 years and over, sexual orientation or gender identity, veteran's status, or other characteristic protected by applicable law.

Applications for this vacancy will be received for 3 working days after the Posted date from Employees of HealthSCOPE Benefits with more than one year of service.

Applications for this vacancy will be received for 10 working days after the Posted date from External Applicants.



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