Provider Coordinator

Will the position be 100% remote? Yes

Are there any specific location requirements? candiadtes should be sourced from 1 of the following 15 states-Client, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI

Must be located in EST

Are there are time zone requirements? Yes EST

What are the must have requirements? Provider Data validation experience, Provider Data auditing experience

What are the day to day responsibilities? Reviewing incoming email/provider applications aProductst primary database to determine if updates are needed, if yes, submit tickets to downstream data entry teams.

Must be comfortable speaking to providers via email, excellent written communication skills.

Is there specific licensure is required in order to qualify for the role? No

What is the desired work hours (i.e. 8am 5pm) 8-5 EST

What additional equipment besides a laptop, keyboard, mouse and headset will be required for this candidate to be successful in this role? Dual monitors & docking station



Required Education:

High School Diploma or equivalent GED



Summary:

This position is responsible for accurately entering provider demographic and contract affiliation information into the health plan system.

Must be able to accurately interpret request and enter into the system in such a way that all data is correct and claims adjudication is optimized.

Essential Functions:

Receive information from outside party(ies) for update of information in computer system(s).

Analyze by applying knowledge and experience to ensure appropriate information has been provided.

Load and maintain provider information into computer system(s) with attention to detail and accuracy in a timely manner to meet department standards of turnaround time and quality.

Audit loaded provider records for quality and financial accuracy and provide documented feedback.

Assist in system/health plan integration. Train current staff and new hires as necessary.

Assist in system related testing.



Knowledge/Skills/Abilities:

Excellent attention to detail

Ability to enter information in a timely manner

Good project management skills

Able to meet deadlines and time constraints

Strong knowledge of Microsoft office including Outlook, Word, Excel, and Access

Ability to lean internal systems QNXT

Excellent verbal and written communication skills

Ability to abide by Client's policies

Maintain regular attendance based on agreed-upon schedule

Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers



Required Education:

High School Diploma or equivalent GED



Required Experience:

0-2+ years managed care experience