Prepare letters to providers and facilities for credentialing/recredentialing/registration decisions and updates including non-compliance.
Review and Process Provider and Mid-Level Registrations in accordance with policies and procedures including but not limited to License Verification, DEA review, and regulatory sanction checks.
Work in conjunction with Professional Relations and Network Management on projects including but not limited to directory verification, access and availability, deficiencies, provider quality issues, etc. to update provider demographic information.
Research and update provider data elements as identified in provider data clean-up projects.
Excellent member and provider experience- accurate and timely onboarding/credentialing and maintenance of provider data ensuring timely payment of claims.
Provide excellent customer service for all inquiries and requests.
Collaborate with the Network Management to ensure a robust provider network so that members needs are met especially in coverage areas with fewer facilities and providers.
Continuously monitor providers’ performance to ensure quality care for members.
Experience
Experience with conducting outbound calls.
Excellent communication skills, phone, verbal, & written.
Medical experience preferred.
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Staffing and Recruiting
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