Job Description

The Provider Demographic Management Coordinator ensures all contracted and non-contracted provider demographics and payment methodologies are accurate and end up to date within MED/MC and ensure integrity and accuracy of provider demographic data.

 

Maintains provider demographic information in MED/MC, including through applicable web interface programs, through the receipt of new provider demographic information, additional information and change information received from providers, provider service representatives, IT department, Network Services Department, Claims Department, audits, and other sources.  Makes corrections to errors as received.  Keeps up to date on all information received, following and keeping within departmental data entry standards.  Downloads provider credentialing (CAQH) applications and checks them for accuracy.  Follows up with providers in a timely manner to obtain missing and/or incorrect documentation.  Participates on calls with regional PDM and IT Department staff to assist with troubleshooting and recommending enhancements to MedMC and related programs.

 

Assists to prepare the agenda, organize handouts and other materials, and takes minutes at monthly Credentialing Committee.  Interfaces with counterparts in Arizona to achieve a smooth credentialing process for providers.  Helps facilitate the Credentialing Committee approval and denial notification process (e.g., Welcome and Denial letters) with other Network Services Department staff.

 

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



Qualifications

Qualifications:

High School Diploma / GED

College coursework / degree preferred

Data Entry in a deadline driven environment

Previous credentialing experience

Typing skills at least 40 wpm

Ability to accurately enter data into information system as instructed

Ability to prioritize workload and function well in a changing environment

Be effective and assertive in both written and spoken communications

Detail oriented

Application Instructions

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