Provider Network Consultant

Position- Sr Prov Data Maintenance Specialist
Onsite

This position is responsible for the analyzing, researching, and applying business rules to complete requests received from providers regarding adds/deletes/changes to their information used for claims processing, membership assignment, and directory purposes. This position is responsible for contracting, credentialing and maintaining Facility / Professional provider data to support marketing, network contracting across all lines of business. This role involves supporting the implementation of special projects, assisting with tracking of various phases of a project and managing workflow. This position includes assisting management in familiarizing and training team members with the various business rules in network contracting and credentialing across all lines of business. In addition is responsible for identifying gaps in processes and suggesting process improvement strategies.

Required Job Qualifications:

• * HS Diploma/GED(education verification required) plus 1 year of experience with Provider Network contracting and credentialing systems OR 5 years of experience in the Health Care industry.
• * Written and verbal communication skills including interpersonal skills.
• * Skills to develop training materials and act as an advisor to staff
• * Experience and proficiency inn Microsoft Office software products including analytical tools. Experience developing reports.

Preferred Job Qualifications:

• * Bachelor Degree
• * Subject Matter Expert for the Professional Provider Credentialing Process
• * 2 years of experience with current government sponsored health insurance networks
• * Knowledge of health care delivery systems, claim costing analytics, and provider network adequacy analytics