Job Summary:
The Provider Network Coordinator I is responsible for the integrity of the data in the provider database system.
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
- Associates 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