The Provider Data Specialist maintains accurate provider demographic information and payment methodologies within the plan's operating systems. They also support reporting functions, coordinate database integrity, and assist with the credentialing committee approval process.
The Credentialing Specialist maintains and loads provider demographic information while ensuring all contracted providers meet qualification standards. They also assist with reporting functions, data analysis, and the facilitation of the Credentialing Committee approval process.
The coordinator manages the intake, research, and resolution of Medicare Advantage appeals and grievances while ensuring compliance with regulatory requirements. They collaborate with internal departments to resolve member and provider concerns and maintain accurate case documentation.
The Intake Coordinator is responsible for receiving, screening, and processing all referral and intake information for the organization. They also perform benefit verification and obtain necessary prior authorizations to ensure services are reimbursable.
The Utilization Review Nurse assesses the medical necessity and quality of healthcare services through pre-service, concurrent, and retrospective reviews. They provide clinical support to the department and medical director to ensure compliance with regulatory guidelines and appropriate patient care.
The Member Advocate will welcome new members, conduct monthly visits, and maintain relationships with network providers and nursing home staff. They are responsible for documenting all activities, ensuring CMS compliance, and coordinating care needs within their assigned region.
The Member Advocate supports local service areas by welcoming new members, conducting monthly visits, and maintaining relationships with network providers and nursing home staff. They are responsible for documenting activities, ensuring CMS compliance, and coordinating with the TruHealth team to meet member needs.
The Member Advocate will welcome new members, conduct monthly visits or contacts, and maintain relationships with network providers and nursing home staff. They are responsible for documenting all activities, ensuring CMS compliance, and addressing member dissatisfaction.
The Provider Relations Representative is responsible for contracting and credentialing providers to ensure network adequacy for Medicare Advantage plans. They also educate providers on health plan functions and monitor relationships to maintain coverage and compliance with CMS standards.
