Provider Network Coordinator

Department: Outside Medical Networks

Job Status: Full Time

FLSA Status: Non-Exempt

Reports To: Director, Provider Networks

Grade/Level: N/A

Amount of Travel Required: 0-5%

Work Schedule:

Positions Supervised: N/A

Generally, 8:00 AM to 5:00 PM, but may require some work outside of standard office hours.

POSITION SUMMARY

The Provider Networks Coordinator is responsible for collecting and storing provider information used to establish and maintain Provider Networks in various Geographic areas. Key focus of this position is Profit and Loss (P&L) for the Outside of the Walls Medical Networks Division and all operational aspects of the business unit. This requires planning, organization, and coordination of all work efforts and relationships with subcontractors. This position helps to ensure that all contract deliverables and performance standards are of the highest quality and results are delivered within contract parameters.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To perform this job successfully, an individual must perform each essential duty satisfactorily. Reasonable Accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statement(s)

• Manage all in network provider information in various areas/databases
• Monitor and Manage provider directories and make updates as needed
• Distribute and communicate updated directory information to external customers
• Obtain missing information from in network and out of network providers and enter into database
• Collect credentialing documents from contracted providers and forward to credentialing team
• Identify plan gaps and work with Director to recruit new specialists
• Assist Director with preparing new provider contract Agreements and packets as needed
• Assist Director with all operational resources and activities to operate within budget, maximize investments, increase effectiveness, and comply with all contract requirements
• Maintain communication with appropriate customer contacts
• Manage all direct communication efforts to ensure that contracted providers are aware of any changes
• Maintain a high level of customer satisfaction
• Attend and participate in conferences and meetings as directed
• Maintain confidentiality of company business
• Comply with HIPAA, Corporate Integrity, and HR policies
• Complete and/or direct the timely delivery of all reports and invoices
• Perform other job-related duties as required or directed
  • Establish and implement essential departmental policies, goals, objectives, and procedures

SKILLS & ABILITIES

Education: High School Diploma required; Bachelor’s Degree preferred

Experience: A minimum of 2 years’ experience in health care or contract administration required.