Provider Network Specialist

Compensation

: $64,580.00 - $104,060.00 /year *

Employment Type

: Full-Time

Industry

: Advertising/Marketing/Public Relations



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Managed Care Organization is looking for a Provider Network Specialist.

Process credentialing and re-credentialing applications of providers, vendors and facilities.

Review provider applications performs primary source verification and maintains Intellicred database.

Contacts providers, including licensing agencies, medical office staff, and insurance carriers to complete credentialing and re-credentialing applications.

Assists in and recruitment and identification of providers where network gaps or needs exist.

Maintains communication with the credentialing contacts at facilities and with providers to coordinate receipt of information required for credentialing, re-credentialing, and updating Monitors the initial and re-credentialing process for all contracted providers ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state), as well as Rules and Regulations, policies and procedures.

Conducts thorough background investigation, research and required primary source verification.

Utilizes the Intellicred credentialing database, optimizing efficiency; performs queries, reporting, document generation, scanning and uploading of provider files.

Leads, coordinates, and monitors the review and analysis of provider applications and accompanying documents, ensuring applicant eligibility.

Supports provider relation retention efforts.

Supports contracts and compliance departmental projects.


Skills/Abilities:

Must have credentialing experience from a health plan

Ability to meet stringent deadlines and to adjust priorities

Strong verbal and written communication skills

MS Office proficiency

Accurate, organized and detail oriented

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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