w3r Consulting · 2 hours ago
Provider Service Representative
Chicago, IL
Contract
Onsite
Entry Level
1+ years expw3r Consulting is seeking a Provider Network Consultant to analyze and apply business rules for provider requests related to claims processing and membership assignment. The role involves managing provider data, supporting project implementation, and training team members on business rules in network contracting and credentialing.
AnalyticsConsultingInformation TechnologyLegal
Hiring Manager
Pooja Kumari
Responsibilities
Analyzing, researching, and applying business rules to complete requests received from providers regarding adds/deletes/changes to their information used for claims processing, membership assignment, and directory purposes
Contracting, credentialing and maintaining Facility / Professional provider data to support marketing, network contracting across all lines of business
Supporting the implementation of special projects
Assisting with tracking of various phases of a project and managing workflow
Assisting management in familiarizing and training team members with the various business rules in network contracting and credentialing across all lines of business
Identifying gaps in processes and suggesting process improvement strategies
Qualification
Required
HS Diploma/GED(education verification required) plus 1 year of experience with Provider Network contracting and credentialing systems OR 5 years of experience in the Health Care industry
Written and verbal communication skills including interpersonal skills
Skills to develop training materials and act as an advisor to staff
Experience and proficiency in Microsoft Office software products including analytical tools. Experience developing reports
Preferred
Bachelor Degree
Subject Matter Expert for the Professional Provider Credentialing Process
2 years of experience with current government sponsored health insurance networks
Knowledge of health care delivery systems, claim costing analytics, and provider network adequacy analytics
Company
w3r Consulting
W3R Consulting is an information technology company that provides advanced analytics and program management services.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
E
Eric Hardy
President and CEO
Company data provided by crunchbase