Provider Relations Coordinator
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AI Summary
The Provider Relations Coordinator acts as a liaison to support the provider network, focusing on onboarding, contract administration, and resolving provider inquiries regarding claims and reimbursements. Key duties include managing provider data accuracy, facilitating internal and external communication, and ensuring compliance with regulatory requirements.
The Provider Relations Coordinator supports the provider network by serving as a liaison between healthcare providers and the organization. This role focuses on assisting with provider onboarding, contract administration, and resolving provider inquiries related to claims, reimbursements, and network policies. The Coordinator ensures provider data accuracy, facilitates communication between internal teams and providers, and helps maintain compliance with regulatory requirements. This position requires strong organizational skills, attention to detail, and the ability to build positive provider relationships.
Key Responsibilities:
- Assist providers with problem resolution and claims issues.
- Assist with member claims issues.
- Input of providers into Salesforce
- Ancillary and PCP education and re-education
- Responses to member inquiries
- Claims utilization reporting through operations
- Beacon and Health Axis ticket analysis
- Upload new agreements into Salesforce.
- Consolidate provider rosters as needed.
- Ensure that Beacon has updated provider information.
- Work the Pre-Check Run for Non-Par Providers
- Reach out to contract new providers.
- Assist with plan growth and contracting.
- Other duties as needed.
Qualifications:
- Bachelor’s Degree Preferred, High School Diploma or GED Required
- Experience working in a health care environment, preferably an HMO/PPO
- Customer service leadership experience preferred.
- Must have a working knowledge of Medicare and Medicaid programs.
- Must have a solid knowledge and understanding of managed care industry.
- Proficiency in MS office suite
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