You will join a team which is collectively responsible for maintaining provider database, includes credentialing and contracting and all other tasks the department is responsible for. You will be expected to coordinate and document provider inquiries, as well as provide prompt and courteous service to requests for assistance for all providers via telephone calls, faxes, and emails. Researches and assists with resolution of claims inquiries regarding reimbursement issues, and health plan payment methods. The successful individual must be able to communicate and collaborate effectively with other internal, as well as external contacts and resources in order to achieve desired results and resolution of issues.
Responsibilities include but are not limited to the following:
- Resolves provider issues by researching causes and working with various health plans.
- Leading and reporting on monthly meetings.
- Responds to provider calls on the Provider Relations Line, as well as emails, voicemails, and faxes seeking assistance.
- Works with providers, health plans, and internal Credentialing Department to ensure provider data accuracy.
- Builds collaborative relationships with multiple health plan representatives.
- Staying updated and providing education to providers on various health plan policies.
- Assisting and completing various projects on time.
- Other duties and projects as assigned in line with Department and company needs.
- Bachelor’s Degree; or two years related experience and/or training.
- Excellent multi-tasking, prioritizing, and time management skills.
- Knowledge and experience with Google applications, Adobe, and Microsoft Office products.
- Proficient in creating and manipulating spreadsheets utilizing intermediate formulas and functions.
- Critical thinking skills to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Strong communication and interpersonal skills to effectively present information and respond to questions from representatives, providers, and the general public.
- Good aptitude for self-sufficiency with the ability to work both independently or closely with other team members as needed.
- Ability to adjust to a potentially changing and fast pace environment.
- Bilingual in Chinese is a plus but not mandatory.