Provider Network Coordinator I

CareSource

United States Remote only

Full time

Business Operations

Remote

Sep 1

Job Summary:

The Provider Network Coordinator I is responsible for the integrity of the data in the provider database system.

Essential Functions:

  • Responsible for the integrity of the data in the provider database system
  • Accurately load provider records for all products and markets into the provider database for use by various internal departments, providers, and our member community
  • Ensure all participating providers have successfully completed credentialing and contracting prior to loading; work with the appropriate team to meet these requirements when necessary
  • Ensure valid documentation is available prior to loading or performing maintenance on provider records and collaborate with various functions to resolve issues when necessary
  • Meet aggressive Service Level Agreements (SLAs) for processing data
  • Adhere to requirements established by external governing bodies such as various state or federal entities
  • Accurately track daily activities through detail workflow queues to meet established productivity and timeliness standards
  • Research and resolve provider data inquiries for various internal departments
  • Respond to emails, phone calls and written requests from providers and internal customers while providing consistent and clear communication
  • Serve as a subject-matter expert for the provider database system content and logic behind daily processing
  • Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvements and to identify issues
  • Continually evaluate current processes for improvement opportunities, submit potential enhancements to management, and participate in process improvement activities
  • Assist in various mandatory projects such as data cleanup, workflow revisions, upkeep of maintenance and other projects as assigned
  • Perform any other job duties as requested

Education and Experience:

  • Minimum of High School Diploma or General Equivalency Degree (GED) is required
  • Associates Degree in a  healthcare related field is preferred
  • Minimum of two (2) years of experience in a managed care environment is preferred
  • Experience using Cactus and Facets is preferred

Competencies, Knowledge and Skills:

  • Proficiency with Microsoft Office, including Outlook, Word, and Excel is required.
  • High speed and accurate data entry skills
  • Knowledge of Medicaid & Medicare managed care is preferred
  • Solid verbal and written communication skills
  • Ability to work independently and within a team environment
  • Time management skills
  • Critical listening and thinking skills
  • Solid decision making/problem solving skills
  • Attention to detail
  • Customer-service oriented

Licensure and Certification:

  • None

Working Conditions:

  • General office environment; may be required to sit or stand for extended periods of time

Organization Level Competencies

  • Leveraging Feedback
  • Customer Orientation
  • Valuing Differences
  • Managing Work
  • Earning Trust
  • Quality Orientation
  • Adaptability
  • Influencing
  • Collaborating


 

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.

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