The Provider Coordinator plays a crucial role in ensuring the accuracy and integrity of provider demographic and contract affiliation information within the health plan system. This role demands meticulous attention to detail and efficiency in processing incoming requests to optimize claims adjudication.
Essential Functions
In this role, you will receive provider information from external sources for system updates and apply your knowledge and experience to validate the provided information. Accurate data entry and maintenance of provider records in the computer system are vital aspects of this position, emphasizing precision and timeliness. Regular audits of loaded provider records are conducted to ensure both quality and financial accuracy, with documented feedback provided when necessary.
You will actively support system/health plan integration efforts and be responsible for training both existing staff and new hires. Additionally, you will assist in system-related testing activities.
Knowledge/Skills/Abilities
The successful candidate will have previous experience in a medical office setting working in provider credentialing or related position. Applicants without experience in claims, coding or credentialing will not be considere.
Strong verbal and written communication skills are essential, along with adherence to Managed Care Organization's policies and confidentiality requirements. Maintaining reliable attendance based on the agreed-upon schedule is mandatory. Understanding and compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations is critical. The ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers is also vital.
Required Education And Experience
To qualify for this role, you must possess a High School Diploma or equivalent GED.
Candidates must have 1+ years of managed care experience and/or medical office experience with coding or credentialing experience.
You must have at least one year of medical office experience for this role.
The Provider Coordinator position offers a unique opportunity to contribute significantly to the accuracy and efficiency of our health plan system. If you are skilled in meticulous data entry and dedicated to maintaining high data quality standards, we encourage you to apply for this position.
Seniority level
Entry level
Employment type
Full-time
Job function
Administrative
Industries
Staffing and Recruiting
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