Provider Servicing Coordinator

Position Summary

Supports the Provider Servicing Manager to achieve department goals. Answers incoming telephone inquiries from groups and assists with problem resolution of issues. Coordinates network group submissions, such as, group updates, monthly rosters, group applications and group listings to internal departments and external customers (i.e. health plan partners, PCPs and network groups).

Duties and Responsibilities

• • Supports the Provider Servicing Specialist with all network group inquires.
• • Provides oversight on inquiries and claims issues following up with respective internal departments and network groups to ensure issues and/or needs have been resolved. Providing Internal departments with any paperwork needed to take care of claims issues. Responds to Network groups and/or health plan partners to close the loop on any inquiries, issues and/or open items.
• • Reviews and processes incoming and outgoing paperwork for existing groups and network update email request and all other related functions in accordance with the department’s Policies and Procedures.
• • Liaison, in conjunction with the Provider Servicing Specialist, for all health plans.
• • Audits all group-submitted requests, associated documents, and files according to the department’s Policies and Procedures for all health plans.
• • Configures group loads on active group updates such as demographic changes, terminations, new lines of business, reimbursement changes, etc. and enters all updates into networks proprietary database.
• • Performs BatchGeo for all contract terminations, location terminations and new group location request in accordance with the department’s Policies and Procedures.
• • Bi-Monthly Group Attestations sent and ensured they are received back signed by groups. This is mandatory to obtain and store in Networks proprietary database.
• • Quarterly expiration reports check to ensure that all expired documents for groups are received within the quarter and stored in networks proprietary database.
• • Sends via email, fax blast and/or certified mail required provider notification and letters.
• • Liaison between Groups to provide Contracting detailed information requested.
• • Special Projects as assigned or directed.

Knowledge

• • Associate’s degree preferred or equivalent directly related experience.
• • Minimum 1+ years’ experience in customer service or claims with exposure to problem resolution.

Skills

• Excellent problem-solving skills
• Proficient oral and written communication skills
• Deductive Reasoning
• Works well individually and/or with team setting
• Intermediate Microsoft Office skills
• Bi-lingual a plus

Abilities

• Organizational skills
• Excellent time management
• Analytical mind frame for reviewing of data

Physical Demands

The physical demands described here are representative of those that must be met by the employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle or feel; reach with hands and arms and talk and hear. The employee is occasionally required to stand; walk and stoop, kneel or crouch. Specific vision abilities required by this job include close vision and ability to adjust focus.

Position Type/ Expected Hours of Work

This is a full-time position. Days and hours of work are Monday through Friday general time span: 8:00 a.m. to 5:00 p.m. Occasional evening and weekend work may be required as job duties demand.

Work Environment

This job operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. The work environment characteristics described here are representative of those encountered while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Travel

This position requires less than 5% travel.

Other Duties

Please note this job description is not designated to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.