Provider Network Performance Coordinator Job at Centers Plan for Healthy Living
Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.
JOB SUMMARY:
The Provider Network Performance Coordinator is responsible for the oversight of the performance and quality of the CPHL provider network.
PRIMARY RESPONSIBILITIES:
Education:
Associate Degree or equivalent work experience. Bachelor Degree strongly preferred.
Experience:
Preferred two years in a Provider Relations role.
Knowledge and Skills:
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JOB SUMMARY:
The Provider Network Performance Coordinator is responsible for the oversight of the performance and quality of the CPHL provider network.
PRIMARY RESPONSIBILITIES:
- Independently conducts in depth investigations of providers who have quality of service or quality of care issues
- Analyzes financial data (claims) to detect irregularities in areas such as billing
- Evaluates network operations to identify risk areas
- Consults on proactive approaches to improve operational performance
- Maintain knowledge of current managed care regulations and trends
- Recommends actions to take after investigations have been completed
- Acts as a liaison between providers, CPHL, and leadership
- Identifies and resolves provider issues both internally and externally
- Conducts on site audits of providers
- Educates providers on complex issues
- Interacts with other departments including Appeals and Grievances, Utilization Management, Claims, etc.
- Other duties as assigned.
Education:
Associate Degree or equivalent work experience. Bachelor Degree strongly preferred.
Experience:
Preferred two years in a Provider Relations role.
Knowledge and Skills:
- Possess a knowledge of Medicaid and Medicare products.
- Excellent verbal and written communications skills.
- Must have strong analytical skills with a positive and proactive mentality.
- Must be a strong planner and possess an ability to make strong decisions.
- Must be able to work independently as well as with a team.
- Possesses strong organizational skills and is able to handle multiple tasks simultaneously.
- Possess excellent time management, problem-solving and organizational skills.
- Must present a professional appearance and demeanor consistent with representing Centers Plan for Healthy Living.
Please Note :
blog.nvalabs.org is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, blog.nvalabs.org provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.