Network Services Representative
The Representative is responsible for the timely and accurate completion of provider file maintenance including, but not limited to, data entry of newly credentialed providers or out-of-network providers, change of address, rate changes, leave of absence and disenrollments.Position Responsibilities:
Perform the data entry requirements to set up and maintain provider files in various computer systems and any functions related to the process of welcoming new providers into the network, such as, but not limited to the execution of provider agreements and the issuance of provider correspondence.
Process ongoing provider file revisions resulting from information received from the provider or information that is generated internally that would require modifications to the electronic record of the provider. Such file changes include, but are not limited to, address changes, W-9 information, changes required for the accurate processing of claims, and fee schedules.
Investigate and resolve claims processing requests and temporary provider records.
Accurately and timely perform data entry of provider demographic and practice location information intocompany systems.
Complete the process required to terminate a provider s participation in the network and any related functions such as, but not limited to, the issuance of correspondence, preparing reports for internal or external parties and communication with field offices.
Research and resolve issues related to provider file information. Support provider file related projects and initiatives. Such projects include but are not limited to the yearly review of W-9 information for the 1099 report, data integrity projects, and special provider file related reports.
Research and respond to provider file related inquiries received from internal or external stakeholders.
Perform pre-data entry duties as assigned including mail receipt and scanning functions according to intake process workflow.
Monitor work queue to ensure applications are processed within expected turnaround times.
Meet or exceed production and quality standards.
Display a positive, constructive, and helpful demeanor.
Education: High School diploma or equivalent.O Associates Degree preferred.
Relevant Work Experience: 2 years experience in insurance, healthcare or related field required.
Knowledge, Skills, and Abilities: o Professional demeanor, strong written and oral communication skills, strong computer skills, and the ability to learn internal systems.
o Detail-oriented, analytical, highly organized and possessing problem-solving skills.
o Ability to manage varying job pressures, and meet deadlines and handle multiple tasks simultaneously with minimal supervision.O Ability to work in a production environment and meet production and quality goals.