Provider Network Coordinator

3 days ago

Dayton OH United States ALTA IT Services Full time

Provider Network Coordinator (2 roles)

Find out more about the daily tasks, overall responsibilities, and required experience for this opportunity by scrolling down now.
ALTA is supporting a contract opportunity working remote located anywhere in the United States

The Provider Network Coordinator I is responsible for the integrity of the data in the provider database system.

ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services.

Essential Functions:

Responsible for the integrity of the data in the provider database system
Accurately load provider records for all products and markets into the provider database for use by various internal departments, providers, and our member community
Ensure all participating providers have successfully completed credentialing and contracting prior to loading; work with the appropriate team to meet these requirements when necessary
Ensure valid documentation is available prior to loading or performing maintenance on provider records and collaborate with various functions to resolve issues when necessary
Meet aggressive Service Level Agreements (SLAs) for processing data
Adhere to requirements established by external governing bodies such as various state or federal entities
Accurately track daily activities through detail workflow queues to meet established productivity and timeliness standards
Research and resolve provider data inquiries for various internal departments
Respond to emails, phone calls and written requests from providers and internal customers while providing consistent and clear communication
Serve as a subject-matter expert for the provider database system content and logic behind daily processing
Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvements and to identify issues
Continually evaluate current processes for improvement opportunities, submit potential enhancements to management, and participate in process improvement activities
Assist in various mandatory projects such as data cleanup, workflow revisions, upkeep of maintenance and other projects as assigned
Perform any other job duties as requested

Education and Experience: Minimum of High School Diploma or General Equivalency Degree (GED) is required
Associate's degree in a healthcare related field is preferred
Minimum of two (2) years of experience in a managed care environment is preferred
Experience using Cactus and Facets is preferred

Competencies, Knowledge and Skills: Proficiency with Microsoft Office, including Outlook, Word, and Excel is required.
High speed and accurate data entry skills
Knowledge of Medicaid & Medicare managed care is preferred
Solid verbal and written communication skills
Ability to work independently and within a team environment
Time management skills
Critical listening and thinking skills
Solid decision making/problem solving skills
Attention to detail
Customer-service oriented

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