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Provider Contracting Specialist
1 month ago
This position will build and nurture positive relationships with Network providers and members by delivering high quality service through regular engagement. Assists with the preparation of provider contracts to ensure the required enrollment data is received. Routinely collects, verifies, and reports all provider demographic changes, additions, deletions, or corrections to the Operations Department. Manages member inquiries regarding provider participation and any potential quality issues. Maintains a functional working knowledge of internal data systems and organizational structure. Strives for high quality work in completing assignments, performs job duties in a timely manner and represents the organization in a positive manner. Works under own initiative, prioritizes own work, and meets agreed timescales.
Duties and Responsibilities:
Initiates, manages, and maintains effective channels of communication with Network providers and health plan members.
Compiles, analyzes, and verifies all pertinent provider data elements for credentialing and new provider enrollment for completeness and accuracy.
Gathers, reviews, and verifies all pertinent provider demographic data elements related to changes, additions, and terminations.
Communicates, orally and in writing, directly with providers and/or external credentialing verification representatives to resolve questions and issues regarding updates and changes in the systems.
Coordinates data collection with Operations to ensure all data is accurately loaded for provider directories and claims processing.
Performs outbound calls regarding provider nominations and recruitment.
Creates resolution documents to address provider issues and increased provider satisfaction. Utilizes probing and problem-solving methods to resolve all inquiries/requests. Identifies, understands, and anticipates providers unexpressed needs and concerns.
Recommend and participate in process improvement opportunities for daily operations.
Manages appropriate provider correspondence including maintenance of the paper and electronic filing systems for provider agreements.
Responds to provider's inquiries related to specific projects.
Coordinates provider interactions with the entire team to ensure provider satisfaction.
Accountable for complying with all laws and regulations associated with duties and responsibilities.
Ensures office supplies are maintained and fills internal supply request approved by management.
Skills:
College preferred or equivalent work experience
2 years of credentialing, enrollment and/or insurance operations experience is required; Healthcare experience is a plus
Must have strong attention to detail
Previous customer service experience is required
Excellent organization skills and able to manage multiple priorities/projects
Ability to use Microsoft Office Suite
Ability to work independently with minimum supervision
Team player with proven ability to develop strong working relationships within a matrix organization
Maintains attendance and operates in accordance to Company standards
Effectively communicates both internally and externally in all forms whether written or verbal
Ability to prioritize, organize, problem solve, coach, and facilitate
Acts in a professional manner and maintains a professional image that represents the company
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