Providence Health & Services Behavioral Health Network Specialist I in Beaverton, Oregon
Providence St Joseph Health is calling a Behavioral Health Network Specialist I to our location in Beaverton, OR.
We are seeking a Behavioral Health Network Specialist I to be responsible for the recruitment and maintenance of the provider panel in support of Providence Health Plans. The PSR is responsible for training and key communication with participating physicians, hospitals, and other medical providers and their office staff. Communication includes identifying issues, resolving disputes, fielding general questions and researching and resolving complex inquiries from the providers. In addition, PSR has responsibility to contract within their defined territory as defined by their manager.
This position may also be responsible for the analysis of the Health Plans provider network in existing and developing service areas. PSRs work together with other Reps at varying degrees of involvement to implement and maintain a panel management strategy. They may be responsible for the development and completion of reports - ad hoc or scheduled.
These responsibilities include, but are not limited to, contract negotiation as a lead or support - as assigned by the manager, contract administration, contracting strategies, contract compliance, contract language and terms, training, communication, and the coordination of network expansions.
1) Train/communicate on a daily basis with Providers and office staff. This may include interpreting complex contractual documentation, resolving complicated financial/capitation/billing questions and handling multiple priorities.
2) Effectively handle angry Providers by identifying the source of their dissatisfaction, diffusing their anger, and resolving the situation.
3) Maintain detailed knowledge of both national and local health care industry trends, laws and regulations.
4) Maintain detailed knowledge of Health Plan products.
5) Prioritize daily work flow. Manage multiple tasks and prioritize appropriately.
6) Assume a major role in mobilizing providers as they assimilate Utilization Management functions.
In this position you will:
Participate in development of Plan-wide internal operations procedures to support the Plans contractual obligations to the Providers. This may include, but is not limited to, working on project teams and/or committees.
Provide initial orientation and on-going training to Providers and their staff as needed. This includes detailed knowledge of billing, interpreting and providing financial analysis of reports.
Review, negotiate and renegotiate provider contracts including rate and contract language provisions. Negotiate provider contracts to support objectives relative to competitive market trends, client expectations, and Health Plan targets.
Maintain knowledge of policies and procedures relating to Utilization Management, Referral Process, and Claims adjudication.
Identify, analyze, and document issues in the provider community and acts as a conduit to upper management.
Support providers with the following: site visits as needed, staff training and support, liaison with physician leader, assist in problem solving with administrative issues, and prepare/present education.
Analyze, interpret, and present utilization, financial, and informational reports to provider.
Evaluate clinical quality measures for quality bonus and identify opportunities for improvement for providers.
Assist Quality Management with resolution of member complaints and access issues.
Work in conjunction with Communications to provide provider data for on-line and hard-copy provider directories.
Work as needed with Vice President of Network Development to develop and implement service area specific provider recruitment plans.
Required qualifications for this position include:
2 years in a behavioral health setting
Experience in public speaking and/or group presentation
Preferred qualifications for this position include:
- Valid Oregon or Washington driver’s license and insured automobile
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple, "Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Analytics/Business Intelligence
Req ID: 302550