Provider Operations Coordinator

South Florida Community Care Network LLC•Sunrise, FL

2d•$20 - $23•Hybrid

About The Position

Perform day to day duties of assuring that providers (individual, group, ancillary, etc.) are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up.

Requirements

Associates Degree or equivalent experience required.
Knowledge of Word and Excel.
Verbal and written communication skills.
Ability to speak clearly and concise.
Must be detail oriented and able to work independently in a fast-changing environment.
Time management skills.
Ability to manage multiple priorities in a fast-paced environment.
Candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

Nice To Haves

2-3 years Customer Service experience preferred.
Provider relations experience preferred.

Responsibilities

Conducts annual after-hours provider survey as mandated by the agency and Florida Healthy Kids Corporation
Manages and maintains Customer Relations Management (CRM) Pool
Abides by all compliance requirements for the Agency Health Care Administration, Department of Insurance, and Centers for Medicare and Medicaid Services as these apply to the Provider Operations Department activities
Assist with out of network negotiations
Assists in answering the Provider Hotline and provides optimal customer services to all callers
Reports and maintains history of all telephone encounters and inquiries raised by providers
Acts as inter-departmental liaison for Claims, Care Coordination, Customer Experience and Utilization Management departments among others
Assist the Provider Operations Representatives and Provider Operations Contract Negotiators with investigation and resolution of provider issues
Receive all provider related mail/email/fax, including address changes, claim reconsiderations, general inquiries and determine completion, accuracy, and route accordingly
Assist in the coordination of completing the credentialing application for providers
Complete internal directory audits
Develop and distribute provider notices via fax/email blast
Educate providers regarding policies and procedures related to referrals and claims submission; web site education, EDI solicitation and problem solving (Provider Hotline)
Performs other duties as assigned.