Provider Operations Coordinator - Network Management

POSITION SUMMARY /RESPONSIBILITIES

Responsible for the recruitment and contract management of all Provider types to ensure network is adequate and meets appropriate access/appointment availability. Interfaces with various departments to resolve provider issues related to service delivery, authorization, access/appointment availability, and specific projects and initiatives in accordance with the health plan’s policies and procedures. Facilitates and monitors provider participation in provider incentive programs, service delivery improvement activities and conducts audits to ensure compliance with regulatory and benefit program requirements. Responsible for analyzing and reporting benchmarks, deliverables and performance standards in accordance with all regulatory requirements. Serves as a subject matter expert (SME) for the core It system for the Network Management functions. Responsible for managing all relevant functions related to the core system as well as management and maintenance of the printed and electronic versions of the provider directory. Responsible for writing policies and procedures as well as revising and updating all provider manuals and other educational materials as required.

EDUCATION/EXPERIENCE

A minimum of five years of experience in customer service delivery, managed health care delivery or managed care operations environment is required (formal education may be substituted in lieu of experience). Demonstrated expertise in problem resolution skills, presentation and communication skills, data management and claims.