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SalaryGeneral Summary
Under direct supervision, work within and across department teams to manage provider and office staff service requests, resolve business partner questions/issues and provide call handling/routing to provider support line. Support provider management activities associated with provider data maintenance, credentialing activities, directory management and intake requests.
Essential Functions
Research, resolve, document and accurately respond to provider, practice, business parter or administor inquires and service requests.
Communicate and coordinate with providers, practices or other departments to ensure accurate information is available to support business needs.
Manage the Committee meetings set up, document Committee findings in the formal meeting minutes and notify staff of Committee decisions.
Monitor and maintain critical provider information in various systems. Review team member quality assurance reports on a regular basis and working with leadership to prepare follow-up documentation.
Act as first-level intake and triage for incoming provider call line, data clean-up efforts and specified team email box requests.
Support the client and regulatory audit process to include pulling required documentation and review of provider files for accuracy.
Gain industry knowledge to support internal and external business partner relationships.
Support the re-credentialing process and audit support functions to NCQA and client standards.
Ensure requested information is delivered within specified timeframe and completed accurately.
Maintain high standards in all written or verbal communications with providers.
Job Specifications
Typically has the following skills or abilities:
Two to four years of general office experience
Proficient with word and spreadsheet applications
Ability to read and write at a level necessary to accomplish the above tasks
Demonstrated ability to identify problems and provide creative solutions
Strong attention to detail, organizational skills and problem solving skills
Excellent written and verbal communication skills
Ability to work independently and in a team environment
Working Conditions
The working environment is generally favorable, lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc.
The above information on this description had been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job range.
Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
