-MUST know Provider space
-exp with Symphony (system similar to Epic – EHR).
- Maintains an accurate database to communicate provider demographic data for claims processing and production of provider directories.
- Ensures policies and procedures related to provider network requirements and processes are documented, maintained, and followed.
- Verifies provider data and reports discrepancies to health plan leadership team, at-risk entities, and system provider information management team.
- Serves as Central Point of Contact for credentialing departments of the system and affiliated physician organizations for plan network participation updates and ACO entity for billing and payment inquiries
Performs analytical projects to support operations and strategic initiatives.
- Identifies and interprets data to understand network performance and develops recommendations to achieve health plan strategic goals.
Will work as part of a team that includes: 1 manager, 1 supervisor, and 2 analysts
- Systems used: HealthRules Payor, Quest Analytics, IHA Symphony, MS Excel, and other Office Suite tools