Responsible for timely and accurate data entry and maintenance of provider records or credentialing and contract information in multiple databases. Researches and resolves questions and complaints, and ensures that information in all databases is accurate and properly configured to support operations.
ESSENTIAL FUNCTIONS
Performs review, correspondence and timely, accurate record set-up and data entry.
Supports internal auditing process to ensure data accuracy and integrity.
Researches and resolves issues and ensures systems are updated, timely, appropriately and accurately.
Responds to requests to update or change information and ensures that all changes are made within operational guidelines and accurately support all other systems related functions.
Researches and responds to providers and other internal staff regarding complex inquiries.
Develops solutions and communicates outcomes by telephone and in writing.
Supports the implementation of new business by ensuring providers are appropriately and accurately loaded in all applicable systems.
Records daily activities using electronic and manual systems as directed.
Provides consultation and information to area offices regarding the composition of the provider network or specific provider statuses.
Forwards provider requests for network inclusion to the area offices for review and approval.
Assists representatives with detailed information in order to answer provider questions and returns provider calls, as requested, to communicate resolution and/or appropriate course of action.
Performs other duties and special projects as assigned.
Requirements/Certifications:
Professionalism on the phone and handling paperwork is critical.
Managed care or other healthcare network development experience preferred.
1-2 years’ experience in customer service, data management, communications, or credentialing verifications required.
1 or more years in healthcare setting.
Ability to type 45-50+ words per minute.
Other standard office equipment including telephone, copy machines, personal computer software and mainframe/LAN data systems.
Must possess a high level of technical aptitude and be able to organize and manage information in multiple system environments; manage multiple priorities, pay close attention to detail as well as be proficient in word processing and spreadsheet applications.
Proven customer service skills and the ability to successfully analyze and procure solutions to problems in a fast paced production based environment.
Additional Information All your information will be kept confidential according to EEO guidelines.
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