Provider Operations Coordinator New York City at Manhattan

Job Description

Supports the Provider Relations Field Representative to achieve department goals. Answer incoming telephone inquiries from providers and assist with problem resolution of issues. Coordinate submission of provider to internal departments via contract maintenance forms.Essential Functions:

• Supports the Provider Relations Field Reps to resolve claims and payment issues.
• Conducts phone outreach as assigned.
• Root cause analysis of operational and health services issues.
• Reviews and processes provider credentialing applications including the loading of the contracts to Omniflow workflow system.
• Monitors incoming provider file maintenanceforms and updates provider systems as applicable.
• Tracks new contracts through Emptoris and SalesForce.
• Audits provider enrollment packets, configuration loads on new and existing contracts via Xcelys.
• Assists with auditing the data for the production of the quarterly provider directory and other SDOH submissions.
• Provides office, project management, provider recruitment and data analysis support.
• Responds to incoming telephone inquiries from providers and assists with problem resolution.
• Special Projects as assigned or directed

Job Requirements

Education: Associates degree preferredExperience: 1 years experience in customer service or claims with exposure to problem resolutionSpecial Skills (e.g. 2nd language): Excellent problem solving skills. Excellent oral and written communication skills. Must be organized and have excellent time management capabilities. Ability to analyze data to identify trends, and variance from goals.
Country: USA, State: New York, City: Manhattan, Company: WellCare Health Plans Inc..