Provider Network Coordinator I

2 weeks ago


Cleveland, United States Professional Management Enterprises Full time $21
Job DescriptionJob Description

Job Summary:
The Provider Network Coordinator I is responsible for the integrity of the data in the provider database system. The position is fully remote, but MUST reside in OHIO. The work schedule is M-F 8am-5pm.
 
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

Licensure and Certification:

  • None
Company DescriptionProfessional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.Company DescriptionProfessional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.

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