Provider Network Coordinator

MedPro Group

129d • $23 - $25

About The Position

Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace. Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in Springfield, Mass., is one of the nation’s leading providers of health and accident insurance products to the higher education market. Join our rapidly growing and fast paced health insurance organization in the Springfield area. The ideal candidate in this position will have an insurance background, or claims paying experience and will be responsible for the timely adjudication of claims (medical, accident, dental, life, etc.) in support of the different product lines administered by Wellfleet.

Requirements

• Associate’s degree in health administration, business administration, health insurance data analysis, or a related field with 3+ years of experience working in the health insurance industry, or an equivalent combination of education and work experience
• Work experience with a focus on medical provider credentialing and recredentialing, vendor utilization oversight and analysis
• Knowledge of provider and vendor network utilization reports
• Excellent verbal and written communication skills
• Ability to work independently and as a member of the team
• Self-motivated with a strong work ethic, taking ownership of all work to achieve performance expectations
• Outstanding attention to detail with the ability to problem-solve, conduct thorough research and provide issue resolutions
• Strong interpersonal and communication skills with the ability to work effectively with both internal team members and external vendors
• Ability to maintain professionalism, composure and diplomacy while working with internal departments and external vendors, under demanding or challenging situations
• Demonstrated ability to efficiently manage multiple assignments and prioritize tasks in a fast-paced environment to meet deadlines
• Strong organizational and time management skills, including thorough and complete follow-up on all time sensitive items
• Proficiency with MS Office Suite including Outlook, Word, Excel and Pivot Tables

Responsibilities

• Receive, review, and maintain efficient processing of provider enrollment, credentialing and recredentialing applications for direct contracts on behalf of health insurance plans
• Verify and analyze provider credentialing applications and supporting documentation for completeness and accuracy
• Review provider licenses, certifications, and other relevant documents to confirm credentials are valid and current
• Utilize the OIG sanctions database for further verification
• Maintain detailed database of providers for initial credentialing and recredentialing renewal dates as well as for reporting purposes
• Communicate with and respond to inquiries from providers regarding process and documentation of initial credentialing and recredentialing applications
• Assist with Member Satisfaction Survey generation, response analysis and tracking to identify ways to improve the member experience
• Assist with implementing new vendor set ups and provide support with ongoing vendor maintenance
• Participate in vendor oversight calls and meetings and document meeting minutes
• Research and provide timely and thorough resolutions to vendors and providers on their inquiries or issues
• Assist the Head of Provider & Network Management and Provider & Network Manager on ad hoc projects that support the Provider Network Team and benefit the company as a whole
• Perform other duties as assigned

Benefits

• Life insurance
• Health insurance
• Dental insurance
• Vision insurance
• 401K retirement plan
• Short- and long-term disability coverage
• Flexible/dependent care spending account
• Tuition reimbursement
• Business casual dress

What This Job Offers

• Education Level: Associate degree
• Number of Employees: 101-250 employees