Provider Relations Analyst
- Coordinate recruitment and credentialing of medical providers across domestic U.S. and Caribbean ports. Collaborate with internal stakeholders to identify network gaps and lead Provider Relations Assistants in preparing credentialing documentation for review by Walt Disney World and Disney Cruise Line governing panels.
- Address medium to high complexity billing and process issues involving providers and vendors. Apply advanced knowledge of claims operations to ensure timely and effective resolution, supporting overall claims management strategies.
- Manage financial reconciliation processes for shared service vendors supporting Walt Disney World, Disney Cruise Line, and Disneyland Resort. Analyze data to identify systemic issues, direct reprocessing efforts, escalate complex matters, and coordinate credit recovery activities.
- Leverage data to generate actionable, fiscally responsible recommendations that inform strategic decision-making and support leadership objectives.
- Oversee operational and account management functions of the Pharmacy Benefit Management program for Workers’ Compensation and Crew Claims across all resorts. Proactively identify and resolve technology and process inefficiencies in collaboration with internal partners.
- Support the implementation of new vendor relationships by aligning vendor processes with existing workflows. Develop operational guidelines and documentation to ensure long-term success and facilitate training.
- Assist the Manager of Provider Relations in optimizing vendor and medical network performance, ensuring vendors and medical providers are effectively meeting business’ expectations.
- Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, SharePoint, Access) and Smartsheet.
- Demonstrated ability to manage multiple priorities and meet deadlines in a dynamic environment.
- Excellent written and verbal communication skills.
- Strong attention to detail with a commitment to accuracy and quality.
- Self-motivated and capable of working independently with effective time management.
- Solutions-oriented mindset with strong analytical and problem-solving capabilities.
- Minimum of 2 years of experience in Risk Management and/or Healthcare settings.
- Minimum of 2 years Disney experience
- Prior experience in claims management, with a strong understanding of related processes and systems.
- Experience in credentialing medical specialists, ensuring compliance with regulatory and organizational standards.
- Familiarity with medical billing practices and terminology.
- Demonstrated ability to compile, analyze, and present data-driven insights and analytics.
- Working knowledge of Florida Workers’ Compensation Law.
- Understanding of maritime laws and regulations.
- Bachelor’s degree
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