Position Summary 

Supports the Provider Servicing Manager to achieve department goals.  Answers incoming telephone inquiries from groups/providers/hospitals and assists with problem resolution of issues.  Coordinates network group submissions, such as, group updates, monthly rosters, group applications and group listings to internal departments and external customers (i.e. health plan partners, PCPs and network groups). 

Duties and Responsibilities

· Supports the Provider Servicing Specialist with all network group inquires. 

· Provides oversight on inquiries and claims issues following up with respective internal departments and network groups to ensure issues and/or needs have been resolved. Providing Internal departments with any paperwork needed to take care of claims issues. Responds to Network groups and/or health plan partners to close the loop on any inquiries, issues and/or open items. 

· Reviews and processes incoming and outgoing paperwork for existing groups and network update email request and all other related functions in accordance with the department’s Policies and Procedures. 

· Liaison, in conjunction with the Provider Servicing Specialist, for all health plans. 

· Audits all group-submitted requests, associated documents, and files according to the department’s Policies and Procedures for all health plans.  

· Configures group loads on active group updates such as demographic changes, terminations, new lines of business, reimbursement changes, etc. and enters all updates into networks proprietary database and TPA database.

· Performs BatchGeo for all contract terminations, location terminations and new group location request in accordance with the department’s Policies and Procedures. 

· Bi-Monthly Group Attestations sent and ensured they are received back signed by groups. This is mandatory to obtain and store in Networks proprietary database. 

· Quarterly expiration reports check to ensure that all expired documents for groups are received within the quarter and stored in networks proprietary database. 

· Sends via email, fax blast and/or certified mail required provider notification and letters.  

· Liaison between Groups to provide Servicing and Contracting detailed information requested. 

· Special Projects as assigned or directed.

Knowledge

· Associate’s degree preferred or equivalent directly related experience.

· Minimum 1+ years’ experience in customer service or claims with exposure to problem resolution.

Skills

· Excellent problem-solving skills 

· Proficient oral and written communication skills

· Deductive Reasoning

· Works well individually and/or with team setting

· Intermediate Microsoft Office skills

  Bi-lingual a plus