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.
REPORTS TO: SUPERVISOR, PROVIDER OPERATIONS
DEPARTMENT: HI-PROVIDER RELATIONS-STATE
POSITION LOCATION: KOPOLEI, HI 96707
- 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.
- High School or GED is required
- Associate's Degree in a related field is preferred
- 1 year of experience in customer service or claims with exposure to problem resolution is required
- 1 year of experience in physician credentialing is preferred
- Demonstrated problem solving skills
- Demonstrated interpersonal/verbal communication skills
- Demonstrated written communication skills
- Demonstrated organizational skills
- Demonstrated time management and priority setting skills
- Demonstrated analytical skills
- Microsoft Outlook is required
- Microsoft Word is required
- Microsoft Excel is required
- SalesForce is preferred
- Xcelys is preferred *LI-RG1