Coordinator-Provider Relations

Job Summary: Coordinator-Provider Relations Acts as the primary contact and maintains effective working relationships with Health plans and payers, External medical groups, patients and administrative personal for provider credentialing. The Provider Credentialing and Health Plan Relations Lead is responsible for all activities for the Provider Credentialing function with the payers. The role encompasses payer specific filings, payer software data maintenance, tracking for timely credentialing activities, reporting and quality control audits. The position requires very strong skills in regards to attention to detail and communication with providers and administrators to effectively collect data and documents. Knowledgeable about provider licensure, certification and payer enrollment requirements. Responsible for analyzing, researching and resolving credentialing related issues such as claims, appeals, provider eligibility and other provider credentialing issues. Trains and monitors the Provider Enrollment team. Performs other duties as needed.

Education and Experience: High School Diploma or GED required. Two years provider health plan and/or medical group credentialing experience required.

Knowledge and Skills: Able to keyboard 40 wpm. Able to use a computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to work calmly and respond courteously when under pressure; collaborate and accept direction. Able to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.

Licensures and Certifications: None