Responsibilities:

• Receives, researches and processes provider/location requests related to additions, changes and terminations and ensures all requests are logged in appropriate database for performance measurement.
• Evaluates, researches and resolves complex provider data maintenance requests and issues. Understands the systems, business process and provider impact of alternative set-ups.
• Evaluates, researches and resolves credentialing requests and issues. Understands the credentialing process and provider impacts of the credentialing process.
• Assists management with database/data integrity issue research and recommends resolutions. Identifies trends related to data structure/set up and reports trends with proposed solutions to management.
• Identifies opportunities to improve processes to ensure efficient turnaround of issues and meets and exceeds established deadlines and performance standards.
• Develops and maintains departmental policies and procedures documentation related to provider data set up.
• Educates providers on plan participation, eligibility and authorization processes through use of the Web or IVR.
• Educates providers regarding contractual obligations.
• Distributes provider/location contracts and follows up to ensure all appropriate contracts are executed prior to provider/location participation on a panel.
• Develops and maintains direct relationships with claims department to coordinate return checks and ensure providers/location payment information is maintained to ensure efficient payments to providers.
• Assists in ensuring all appropriate documentation is maintained in document management application.
• Meets performance and quality metrics.
• Implements/participates in other provider relations team projects as requested.

Preferred qualification:

• Associate or Bachelor’s Degree
• Customer service and/or data analysis experience
• Experience within health care industry
• Analytical ability in understanding business processes/impact of decisions
• 3-5 mandatory and/or minimum requirements: SQL, R, Excel, experience with complex data cleansing
• Integration and reconciliation, experience with process automation
• 7+ years of experience focused on data analytics/management