We are recruiting for a Network Engagement Specialist in Fresno, CA.

The Network Engagement Specialist is responsible for coordinating necessary ancillary services for member discharged from inpatient and outpatient settings, acute care and post-acute care settings. This role includes overseeing provider communications, issue resolutions, case submissions, and case closures, as well as managing data exchanges with our Care Partners, local hospitals, and other in and out of network providers. By building strong connections between UPN and our provider pattners, the Network Engagement Specialist will enhance collaboration and service delivery. Additionally, the Specialist will educate local hospitals, skilled nursing facilities, and other ancillary providers on UPN's processes and workflows. This position is crucial for ensuring that members receive the necessary Durable Medical Equipment (DME) supplies and other ancillary services promptly. The Specialist will also facilitate efficient routing to in-network Skilled Nursing Facilities (SNFs) when needed. This role involves a mix of administrative tasks and project management, with a strong focus on enhancing member satisfaction and maintaining effective provider relationships. The Specialist will work closely with the Chief Medical Officer (CMO) and the Contracting & Managed Care Officer, reporting directly to the Provider Relations Manager. 

Performance Area 1: Provider Account Management

• Work closely with local hospitals, healthcare providers, and in-network SNFs to coordinate discharge plans and ensure effective member routing.
• Act as the primary point of contact for members requiring DME supplies upon hospital discharge, ensuring timely and accurate delivery of equipment.
• Maintain accurate records of member interactions, equipment requests, and discharge plans in the organization's database.
• Intake Peer-to-Peer requests and process according to establish protocols.
• Ongoing, professional, and effective communication with all providers in UPN's network
• Maintain a professional relationship with all internal and external care partners.
• Provide exceptional customer service

Performance Area 2: Provider Education and Network Management

• Handle administrative tasks related to provider relations, including documentation, reporting, and follow-up communications.
• Assist in the development and implementation of projects aimed at improving processes related to DME supply distribution and member transitions to SNFs.
• Address and resolve any issues or concerns raised by members or providers regarding DME supplies or facility placements.
• Pro actively research and resolve provider issues including but not limited to claims submission, processing, and payment, contracting details, provider tools, and UM and other protocols.
• Ensure accurate ongoing submission of key provider data elements, updates and changes.
• Support providers through the credentialing/re-credentialing process, including addressing provider questions, ensuring timely completion of applications, and suppotting UPN's credentialing team.
• Provide orientations to contracted ancillary providers, ensure alignment and understanding of UPN.
• Collaborate with internal and external care pattners in the creation and distribution of orientation and educational materials to all levels of personnel within a hospital, and ancillary services settings.
• Build provider awareness and engagement with UPN for potential contract opportunities for ancillary services and hospital partnerships. 
• Other network management tasks as assigned not limited to ancillary network.

Performance Area 3: Cross Functional UPN Support

• Answer UPN customer service phone line to appropriately address and/or reroute inquiries.
• Oversee incoming mail, organize and distribute to the appropriate personnel.
• Audit Health Plan provider rosters and directories to ensure UPN Network providers are listed accurately. Work with the Management Service Organization and Health Plans to address any deficiencies.
• Administrative support to Contracting and Managed Care Officer and Chief Medical Officer as needed.
• Serve as internal UPN provider advocate by communicating key provider pain points and work with key stakeholders to advance support of UPN's contracted ancillary providers.
• Collaborate with Marketing, Sales, Provider Data, Credentialing, Operations, and other teams to coordinate cross-functional in-market activities.
• Assist in the development and implementation of projects aimed at improving processes related to DME supply distribution and member transitions to SNFs.
• Work closely with the CMO, Contracting & Managed Care Officer, and Provider Relations Manager to align initiatives with organizational goals and improve care transitions.
• Ensure compliance with all relevant regulations and organizational policies related to member care and provider relations.
• Track claims that were erroneously sent to the UPN Office and re-route them to UPN's Claims team for proper processing. Contact the facility to ensure that future claims are sent to the correct address.
• Other duties as assigned by the Contracting and Managed Care Officer, CMO, and Provider Relations Manager.

QUALIFICATION REQUIREMENTS:

EDUCATION:

• High School Diploma or GED required
• Bachelor's degree in Business, Health Care Administration, Communications or a related field is preferred; equivalent work experience and education will be considered in lieu of a degree.
• Completed training program in Medical Assisting from Accredited College is preferred.

PRIOR EXPERIENCE:

• Two (2) or more years of experience in the healthcare industry navigating relationships around providers and insurance networks is preferred.

LICENSE/CERTIFICATION:

• Possess a valid CA driver's license.

SKILLS:

• Bilingual (English/Spanish) is preferred.
• Must be able to establish rapport and effective working relationships with providers and health center administrators.
• Must have excellent communication skills including negotiation skills; must be persistent and persuasive.
• Must have advanced proficiency in various computer applications and exemplary email communications skills.
• Must be able to prioritize multiple responsibilities and manage a large workload within budget and time lines.
• Must have excellent problem-solving skills and self-motivation.
• Must have the ability to develop alternative solutions to problems.
• Must be able to prepare clear, concise, thorough, meaningful, and grammatically correct written reports, letters, memos and other documents.
• Must be able to independently plan, organize, prioritize, schedule, coordinate, and make decisions related to assigned responsibilities.
• Must have a very strong customer service orientation, positive attitude, and be highly self motivated, directed, and change oriented.