Job Description

Job Description

The Provider Operations 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

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