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Wellfleet · 5 hours ago

Provider Network Coordinator

United States

Full-time

Remote

Mid Level

$23/hr - $25/hr

3+ years exp

Wellfleet, a Berkshire Hathaway company, is a leading provider of health and accident insurance products, particularly in the higher education market. They are seeking a Provider Network Coordinator to manage provider enrollment, credentialing, and recredentialing, ensuring efficient processing and communication with providers.

Employee BenefitsHealth CareInsuranceInsurTechLife Insurance

Responsibilities

Receive, review, and maintain efficient processing of provider enrollment, credentialing and recredentialing applications for direct contracts on behalf of health insurance plans

Verify and analyze provider credentialing applications and supporting documentation for completeness and accuracy

Review provider licenses, certifications, and other relevant documents to confirm credentials are valid and current. Utilize the OIG sanctions database for further verification

Maintain detailed database of providers for initial credentialing and recredentialing renewal dates as well as for reporting purposes

Communicate with and respond to inquiries from providers regarding process and documentation of initial credentialing and recredentialing applications

Assist with Member Satisfaction Survey generation, response analysis and tracking to identify ways to improve the member experience

Assist with implementing new vendor set ups and provide support with ongoing vendor maintenance

Participate in vendor oversight calls and meetings and document meeting minutes

Research and provide timely and thorough resolutions to vendors and providers on their inquiries or issues

Assist the Head of Provider & Network Management and Provider & Network Manager on ad hoc projects that support the Provider Network Team and benefit the company as a whole

Perform other duties as assigned

Qualification

Health insurance experienceProvider credentialingVendor oversightMS Office SuiteCommunication skillsAttention to detailOrganizational skills

Required

Associate's degree in health administration, business administration, health insurance data analysis, or a related field with 3+ years of experience working in the health insurance industry, or an equivalent combination of education and work experience

Work experience with a focus on medical provider credentialing and recredentialing, vendor utilization oversight and analysis

Knowledge of provider and vendor network utilization reports

Excellent verbal and written communication skills

Ability to work independently and as a member of the team

Self-motivated with a strong work ethic, taking ownership of all work to achieve performance expectations

Outstanding attention to detail with the ability to problem-solve, conduct thorough research and provide issue resolutions

Strong interpersonal and communication skills with the ability to work effectively with both internal team members and external vendors

Ability to maintain professionalism, composure and diplomacy while working with internal departments and external vendors, under demanding or challenging situations

Demonstrated ability to efficiently manage multiple assignments and prioritize tasks in a fast-paced environment to meet deadlines

Strong organizational and time management skills, including thorough and complete follow-up on all time sensitive items

Proficiency with MS Office Suite including Outlook, Word, Excel and Pivot Tables

Benefits

Life, health and dental, vision, 401K retirement plan, short- and long-term disability coverage, flexible/dependent care spending account, tuition reimbursement