Our culture promotes an environment where individuality and diverse mindsets collaborate and inspire each other to be better. Our enthusiastic and invaluable team members are encouraged and empowered to create reliable top-drawer solutions, not only for our internal but for our external stakeholders as well.
Our core values and purpose-driven mindset fostering continuous and never-ending improvement (C.A.N.I.) are evident and palpable throughout our organization and kept alive by our team. PNS is a company where you will be embraced by colleagues who want to see you grow in an environment where you will be inspired to become the very best version of yourself.
COMMITTED TO TEAM SUCCESS
TREAT EACH OTHER LIKE FAMILY
CHALLENGE OURSELVES TO BE BETTER
C.A.N.I. ATTITUDE
WE GOT YOU
EVERY VOICE MATTERS
It’s simple. We are more than a workplace.
To us, you are more than an employee. We strive to provide you a place to grow, achieve, and succeed! We have accomplished this through:
We are always eager to meet fresh talent. Here, at Provider Network Solutions, you’ll do more than join an organization— you’ll become part of the family.
There is a place here for every kind of brilliant.
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Join our Team today!
Location: Miami, FL – Full Time
The Claims Examiner III is responsible for processing submitted electronic claims to ensure proper filing procedures and that processing guidelines and rules have been followed. The Claims Examiner III also validates claim or referral submissions to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
Location: Miami, FL – Full Time
The Compliance Auditor is responsible for the review of the Company and delegated entities’ business practices, enforcing compliance with pertinent regulations, such as all federal and state relevant regulations and standards, applicable contractual requirements established by the organization’s clients and internal policies and procedures. Such audits and/or monitoring may occur annually or at other intervals and may include reviewing documentation and other records, as well as interviewing executives and employees. In instances where a potential and/or current non-compliance with a regulation or set of regulations is identified, the Compliance Auditor is responsible for recommending improvements to business processes to ensure that the operational department comes into compliance. Additionally, the Compliance Auditor is charged with evaluating the plan to implement any needed change, ensuring that steps within the plan are effective and addressing the root cause of the non-compliance issue.
Location: Miami, FL – Full Time
The Configuration and Data Integrity Manager is responsible for implementing and interpreting the organization's overall claims, provider configuration, eligibility and provider database management, security, and operations. The Configuration Manager will work with internal departments and external organizations to assure secure data exchanges, integrity, reliability, and availability; plans, organizes and coordinates activities related to the analysis and implementation of network database systems; provides technical guidance and database compliance audits; and consults with business users regarding the use and management of data.
Location: Miami, FL – Full Time
Supports the Contracting and Credentialing Department’s new groups contracting and credentialing needs to achieve department goals, according to the Department’s Policies and Procedures. Coordinates network provider submissions, such as, provider applications and network agreements to internal systems and departments (i.e., Health Plan partners, External Customers, Credentialing System, PR Site, Quick Cap, etc.).
Location: Miami, FL – Full Time
The Director of TPA Operations will be responsible for leading and overseeing all functions within the Claims, Revenue Cycle Management, Auditing, Customer Service, and Data Integrity departments. This role will involve close collaboration with the VP of TPA Operations and department heads to ensure the efficient processing and management of TPA operations for providers, while ensuring full compliance with federal and state regulations.
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At Provider Network Solutions, we’ve worked throughout the company to comply with privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a federal law designed to ensure the privacy of personal and health information. In addition to all federal laws, Provider Network Solutions also complies with all state laws and regulations. If you have any questions or would like to report any issues regarding our Privacy Program, please email our Privacy team at privacy@pns-mgmt.com.
Provider Network Solutions, its subsidiaries, and its affiliates’ certification decisions are based only on the appropriateness of care and service and the existence of coverage. Provider Network Solutions, its subsidiaries, and its affiliates do not reward physician reviewers, case managers, employees, practitioners, or other individuals for issuing denials of coverage or service. Provider Network Solutions, its subsidiaries, and its affiliates do not pay incentives to physician reviewers, case managers, employees, practitioners, or other individuals to reduce the provision of care which is deemed medically necessary. Provider Network Solutions, its subsidiaries, and its affiliates do not give financial incentives to physician reviewers, case managers, employees, practitioners, or other individuals to encourage decisions that result in under-utilization of care or services.
We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. You may access the Nondiscrimination and Accessibility notice by clicking here.
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