Department: Outside Medical Networks
Job Status: Full Time
FLSA Status: Non-Exempt
Reports To: Director, Provider Networks
Grade/Level: N/A
Amount of Travel Required: 0-5%
Work Schedule:
Positions Supervised: N/A
Generally, 8:00 AM to 5:00 PM, but may require some work outside of standard office hours.
POSITION SUMMARY
The Provider Networks Coordinator is responsible for collecting and storing provider information used to establish and maintain Provider Networks in various Geographic areas. Key focus of this position is Profit and Loss (P&L) for the Outside of the Walls Medical Networks Division and all operational aspects of the business unit. This requires planning, organization, and coordination of all work efforts and relationships with subcontractors. This position helps to ensure that all contract deliverables and performance standards are of the highest quality and results are delivered within contract parameters.
ESSENTIAL FUNCTIONS
Reasonable Accommodations Statement
To perform this job successfully, an individual must perform each essential duty satisfactorily. Reasonable Accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statement(s)
- Establish and implement essential departmental policies, goals, objectives, and procedures
- Manage all in network provider information in various areas/databases
- Monitor and Manage provider directories and make updates as needed
- Distribute and communicate updated directory information to external customers
- Obtain missing information from in network and out of network providers and enter into database
- Collect credentialing documents from contracted providers and forward to credentialing team
- Identify plan gaps and work with Director to recruit new specialists
- Assist Director with preparing new provider contract Agreements and packets as needed
- Assist Director with all operational resources and activities to operate within budget, maximize investments, increase effectiveness, and comply with all contract requirements
- Maintain communication with appropriate customer contacts
- Manage all direct communication efforts to ensure that contracted providers are aware of any changes
- Maintain a high level of customer satisfaction
- Attend and participate in conferences and meetings as directed
- Maintain confidentiality of company business
- Comply with HIPAA, Corporate Integrity, and HR policies
- Complete and/or direct the timely delivery of all reports and invoices
- Perform other job-related duties as required or directed
SKILLS & ABILITIES
Education: High School Diploma required; Bachelor’s Degree preferred.
Experience: A minimum of 2 years’ experience in health care or contract administration required.
PHYSICAL DEMANDS
Physical Demands
Lift/Carry
Handling / Fingering
F (Frequently)
Reach Outward
F (Frequently)
Reach Above Shoulder
O (Occasionally)
Squat or Kneel
N (Not Applicable)
10 lbs or less
O (Occasionally)
11-20 lbs
O (Occasionally)
21-50 lbs
N (Not Applicable)
51-100 lbs
N (Not Applicable)
Over 100 lbs
N (Not Applicable)
12 lbs or less
O (Occasionally)
13-25 lbs
O (Occasionally)
26-40 lbs
N (Not Applicable)
41-100 lbs
N (Not Applicable)
Other Physical Requirements: Speak, Hearing, Vision
WORK ENVIRONMENT
General office environment. Work is generally sedentary in nature, but may require standing and walking for up to 10% of the time. The working environment is generally favorable. Lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc. Work is generally performed within an office environment, with standard office equipment available.
Heritage Health Solutions, Inc. is a equal opportunity employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, disability or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.
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