Provider Network Operations- Database Management Support- HYBRID
2 weeks ago
Summary
Under the Provider Network Operations (PNO) Database Management Supervisor's general direction, the PNO Database Management Support I is responsible for ensuring accurate, timely, and efficient provider profile creation in all Client IPA databases. This position's primary function is to create provider profiles in the database for newly contracted providers within each Client IPAs' provider network, ensuring that all processes and procedures are completed according to established MedPOINT Management (MPM) policies and procedures, and contracted terms.
Duties and Responsibilities
• Responsible for creating provider profile in Client databases
• Ensure valid documentation from CPPA, CAQH, Client Liaison or PNO Contract Team is available before creating provider profile
• Follow-up with providers to gather all onboarding required documents
• Respond to emails, phone calls and written requests from provider offices and internal MPM teammates while providing consistent and clear communication
• Work closely with the Credentialing, PNO Contract and Network Management team to ensure provider onboarding process is efficient and complete
• Accurately track daily activities through detail workflow queues to meet established productivity and timeliness standards
• Maintain accurate Client databases by completing regular review and audits
• Foster open lines of communication with Leadership on any network changes or issues
• Provide exceptional customer service to ensure both IPA client and contracted provider satisfaction with the IPA
• Assist in various mandatory projects such as data cleanup, workflow revisions, database maintenance and other projects as assigned
• Perform additional duties/assignments as needed
Minimum Job Requirements
• High School Diploma or GED required, Bachelor’s degree in healthcare, human services or related field preferred
• 1+ years Managed Care or Healthcare experience in Network Management, a plus
• EZ-CAP knowledge and experience preferred
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
Skills and Abilities
• Strong communication skills, including both oral and written
• Ability to maintain multiple priorities and deadlines, with strong follow through
• Highly motivated with excellent attention to detail
• Ability to work independently and take direction
• Ability to quickly learn and use new software tools
• Demonstrate commitment to the organization’s core values
• Ability to provide and receive constructive job-related feedback
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