Network Provider Advocate

• Assist in end-to-end resolution of VA CCN provider abrasion issues, which include identifying and remediating operational short falls, researching and remediating claims or contracting issues as well as identifying areas to enhance call quality
• Assist in efforts to enhance ease of use of physician portal and future service enhancements
• Contribute to design and implementation of programs that build positive relationships between the health plan and internal network partners as well as our VA CCN providers and the VA
• Provide trainings to external providers through educational programs
• Identify gaps within the network to assist with network contracting and development
• Coaches, provides feedback, and guides others to assist in facilitating resolution of issues
• Assesses, interprets and identifies solutions to non-standard requests and problems in order to resolve customer needs and requirements
• Solves moderately complex problems and/or conducts moderately complex data analyses

• 3+ years of health care/managed care experience
• 2+ years of provider relations and/or provider network experience
• Intermediate level of proficiency in claims processing and issue resolution
• Knowledge of Medicare and Medicaid (CMS) regulations
• Proficiency with MS Word, Excel (Pivot Tables and VLookup functions), PowerPoint
• Proficiency with NBD

• Knowledge of Microsoft Access
• Commitment to high-quality results through the use of time, resources and effort
• Understand and takes to heart the need to keep people informed displaying strong communication skills
• Looks for opportunities to collaborate and build relationships improving work product and services
• Demonstrates confidence that tasks will be completed and deliverables will be provided in the midst of competing demands and pressure-filled situations
• Be resourceful and creative in solving problems that don't have clear solutions or outcomes
• Works with minimal guidance; seeks guidance on only the most complex tasks
• Experience in a network management-related role handling complex issues for network providers with accountability for business results

Last updated on Nov 15, 2023