Supports the Provider Relations Field Representative to achieve department goals. Responds to customer service and provider relations inquiries from providers and assist with problem resolution of issues. Coordinates provider submissions to internal departments via required forms.
Department: Provider Relations
Reports to: Supv, Provider Operations
- Works directly with internal and external partners to collect all required information to ensure correct processing of contracts, amendments and update requests.
- Works with delegated providers and IPAs to process new provider load requests along with any updates or changes within the group via a roster methodology.
- Supports the Provider Relations Representatives in resolving claims and payment issues.
- Performs root cause analysis of delays in provider loading and assists in bringing to resolution.
- Audits configuration loads on new contracts.
- Provides office, project management, provider recruitment and data analysis support.
- Performs special projects as assigned or directed.
- May support provider enrollment and credentialing activities.
- Required A High School or GED
- Preferred An Associate's Degree in a related field
- Required 1 year of experience in customer service or claims with exposure to problem resolution
- Preferred 1 year of experience in physician credentialing
Licenses and Certifications:
- Intermediate Demonstrated problem solving skills
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated organizational skills
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Demonstrated analytical skills
A license in one of the following is required:
- Required Intermediate Microsoft Outlook
- Required Beginner Microsoft Word
- Required Intermediate Microsoft Excel
- Preferred Beginner SalesForce
- Preferred Beginner Xcelys