Provider Data Senior Associate - Nashville, TN (office based)

SUMMARY:

The Network Operations Department is responsible for the financial and operational activities of the provider network. In this role, you will be exposed to all aspects of a Coordinated Care Organization (financial understanding, provider network building, conflict/issue resolution, contracting, claim payments, meetings, training, etc.). This role supports the Network Operations Administrators and Representatives.

RESPONSIBILITIES:

* Researching and resolving provider issues such as authorization and claim issues

* Identify the right parties or resources, internally and externally, to resolve issues timely.

* Prepares documentation for meetings, schedules meetings, and educates providers regarding member benefits and the referral process

* Develops, maintains, and distributes reports for assigned provider groups

* Submitting change requests to update provider demographics, group information, contract changes)

QUALIFICATIONS:

Minimum - Bachelor's Degree

Also Preferred:

* Strong knowledge of healthcare insurance industry, terminology, provider networks, contracting and credentialing.

* Ability and willingness to share knowledge.

* Detail oriented, with proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards).

* Be a positive role model and have the ability to work independently and in conjunction with co-workers of all levels.

* Strong analytical and problem-solving skills.

* Excellent communication skills – verbal, written and presentation.

* Working knowledge of SharePoint, Microsoft Word, Excel, & Access.