Provider Network Operations Support Coordinator

Capital Blue Cross•Harrisburg, PA

About The Position

This position will be responsible for the day-to-day support needed from Network Operations, which includes Credentialing, Provider Data, Provider Support and Provider Innovations. The standard day to day support will include managing vendor invoicing against budgeted allowances, analyzing service level agreements against contract terms and invoice payments. This position will also have primary responsibility with provider data verification and support provider attestation and access availability outreach to support NCQA and other regulatory needs. Coordinates department policies and procedures, updating documents as needed and supporting stake holder inquiries related to SharePoint issues. Acts as Access Coordinator, this includes new hires, changes in positions or removing access as necessary. Coordinates the Provider Manual updates as necessary for Network Operations, MyCare Finder user guide and Provider Maintenance user guide. Serves as a primary interface between internal departments to ensure multi and inter disciplinary vendor project coordination.

Requirements

Strong verbal and written communication skills.
Ability to apply sound business judgment in making decisions that affect the Plan.
Demonstrated strong analytical and problem solving skills.
Ability to prepare and use financial and other reports and interpret results.
Ability to meet deadlines and manage multiple priorities.
Ability to demonstrate initiative and act independently in resolving issues.
Knowledge of the English language, especially spelling, punctuation and grammar.
Standard office practice and procedures including appropriate form and format of business correspondence and reports.
Basic mathematics and the ability to balance budget reporting.
3 years’ experience in an office setting support position.
High school diploma or GED

Responsibilities

Identify and execute all department changes as the Access Coordinator.
Conduct provider outreach phone calls to support ongoing NCQA and other regulatory requirements related to provider access and availability surveys.
Conduct provider outreach phone calls to support provider attestation to stay in compliance with state and federal regulations.
Update/Modify department policies and procedures as needed.
Update/Modify all user guides for both internal and external facing training tools.
Serves as a point of contact for department for requests for information. Prioritizes requests.
Review claims data to determine opportunities for additional savings.
Vendor relationships: Maintain issues logs and ensures appropriate staff are engaged with vendor activities and follow through on resolution of issues. Acts as primary point of contact with contract issues with vendors. Monitor vendors’ performance to contract including performance guarantees and service levels. Acts as liaison with vendor and Network Operations.
Process all vendor invoicing and balance to budget. Track vendor invoicing against claims processed and budget.
Review processed claims to determine opportunities for additional savings.
Participates in special projects as assigned. May involve reviewing data concerning issues affecting department functions and operations.
Other duties assigned by the Manager.