24 Oct
NuView Treatment Center
Tiruppur
Company Overview : We are currently credentialed as an Out-of-Network (OON) provider and seek a motivated Insurance Network Specialist to help transition our facility to in-network status with various insurance companies, Employee Assistance Programs (EAPs), and other trusted behavioral health networks.
Job Responsibilities:
- Provider Relations: Serve as the primary point of contact for insurance companies' provider relations or network development teams. Work to secure in-network contracts with relevant payers, including major insurance companies and specialized behavioral health networks.
- Research Insurance Networks: Identify potential insurance payers that cover behavioral health services, including major providers like Aetna,
Blue Cross Blue Shield, Cigna, UnitedHealthcare, and regional/state-specific insurers. Explore opportunities to join specialized behavioral health networks (e.g., Beacon Health Options, Magellan Health).
- Submit Applications: Manage the application process for joining insurance networks as an in-network provider. Submit required documentation, such as facility accreditation, proof of liability insurance, and NPI/TIN information. Assist in reviewing and negotiating contracts with insurers.
- EAP Networks: Reach out to Employee Assistance Programs (EAPs) such as Cigna EAP, Optum EAP, Magellan EAP, and ComPsych. Guide the facility through the process of becoming an in-network EAP provider by submitting specialized applications and emphasizing our ability to provide high-quality employee-focused services.
- Explore Other Provider Networks: Identify opportunities for the facility to join workers' compensation networks, Medicaid/Medicare provider networks, and other government or third-party behavioral health networks (e.g.,
Evernorth Behavioral Health, Tricare, Health Net).
- Site Visits and Inspections: Coordinate with insurance companies, EAPs, and other behavioral health networks regarding any required site visits or facility inspections. Ensure compliance with safety, quality, and health standards.
- Quality Assurance and Reporting: Maintain the facility’s credentials and oversee quality assurance processes to ensure the facility meets the ongoing requirements of insurance networks and other provider panels.
Work Timings:
The ideal candidate will be expected to align their work hours with the US Business Development and Digital Marketing teams, requiring availability from 4:30 PM to 12:30 AM IST.
Qualifications:
- Experience in insurance contracting and credentialing,
specifically in the behavioral health or healthcare industry.
- Strong knowledge of the insurance landscape, including major health insurers, EAPs, Medicaid, Medicare, and third-party behavioral health networks.
- Familiarity with the application, negotiation, and contracting processes for healthcare facilities.
- Excellent communication and negotiation skills.
- Strong organizational and project management skills.