Contracting Coordinator

Provider Network Solutions LLC; Miami (FL); On-site; USD 42,000 - 62,000; Full time

Job summary

Provider Network Solutions LLC in Miami, FL, is seeking a Credentialing and Contracting Support professional to help the department meet its goals.

You will research providers, process credentialing paperwork, coordinate with health plans, and maintain CRM records. The role emphasizes communication, problem-solving, and timely handling of provider submissions.

Experience in healthcare customer service and an associate degree preferred, with bilingual abilities considered a plus.

Qualifications

• Associate degree preferred or equivalent directly related experience.
• Minimum 1+ years' experience in customer service or healthcare.
• Excellent problem-solving skills.
• Proficient in oral and written communication.
• Bilingual a plus.

Responsibilities

• Research New Provider, Centers, Hospitals information to load in leads listing.
• Mailings, Faxes and Emails to all leads found in research to include all Network documentation required by networks and health plan partners.
• Supports all Field Representatives to obtain agreements, Credentialing and Health Plan request documentation; while managing new Physician groups, existing groups new Physicians, Centers, Hospitals and/or additional HP requests.
• Reviews and processes incoming and outgoing required paperwork, including provider credentialing applications, welcome letters, and all other related forms, according to the Department's Policies and Procedures.
• Make outbound calls to new lead targets and/or follow up calls for Providers, Groups and/or Hospitals that the Contracting Representatives have met with.
• Answers incoming telephone inquiries from providers and assists with the resolution of Contracting/Credentialing issues/needs.
• A liaison in conjunction with all Contracting Specialists and Credentialing Coordinators for all Health Plans and affiliates for new external customers groups inquiries/submissions.
• Audits credentialing packets and tracks new credentialing applications with all Health Plan partners.
• Configs provider loads on new Physicians from new and existing groups, and updates provider's status.
• Liaison between Network and Health plans for the monthly Provider Reports.
• GeoAccess and BatchGeo reports on a quarterly basis and/or as needed for new networks.
• All Network comparison reports for new and/or existing health plan partners and networks.
• Special Projects as assigned or directed.
• Updating and maintaining current CRM platform (Monday.com) to reflect progress of ongoing leads negotiations.

Skills

Excellent problem-solving skills

Microsoft Office

Teamwork

Deductive Reasoning

Communication skills

Bilingual a plus

Education

Associate degree preferred or equivalent

Job description

Description

Position Summary

Supports the Contracting and Credentialing Department's new groups contracting and credentialing needs to achieve department goals, according to the Department's Policies and Procedures. Coordinates network provider submissions, such as, provider applications and network agreements to internal systems and departments (i.e., Health Plan partners, External Customers, Credentialing System, PR Site, Quick Cap, etc.).

Duties and Responsibilities

• Research New Provider, Centers, Hospitals information to load in leads listing; including but not limited to Provider Groups, Provider names, addresses, phone and faxes, etc.
• Mailings, Faxes and Emails to all leads found in research to include all Network documentation required by networks and health plan partners.
• Supports all Field Representatives to obtain agreements, Credentialing and Health Plan request documentation; while managing new Physician groups, existing groups new Physicians, Centers, Hospitals and/or additional HP requests.
• Reviews and processes incoming and outgoing required paperwork, including provider credentialing applications, welcome letters, and all other related forms, according to the Department's Policies and Procedures.
• Make outbound calls to new lead targets and/or follow up calls for Providers, Groups and/or Hospitals that the Contracting Representatives have met with.
• Answers incoming telephone inquiries from providers and assists with the resolution of Contracting/Credentialing issues/needs.
• A liaison in conjunction with all Contracting Specialists and Credentialing Coordinators for all Health Plans and affiliates for new external customers groups inquiries/submissions.
• Audits credentialing packets and tracks new credentialing applications with all Health Plan partners.
• Configs provider loads on new Physicians from new and existing groups, and updates provider's status. Entries made in credentialing system, provider system and TPA system.
• Liaison between Network and Health plans for the monthly Provider Reports.
• GeoAccess and BatchGeo reports on a quarterly basis and/or as needed for new networks.
• All Network comparison reports for new and/or existing health plan partners and networks.
• Special Projects as assigned or directed.
• Updating and maintaining current CRM platform (Monday.com) to reflect progress of ongoing leads negotiations.

Requirements

Knowledge

• Associate degree preferred or equivalent directly related experience.
• Minimum 1+ years' experience in customer service or healthcare with exposure to problem resolution.

Skills

• Excellent problem-solving skills.
• Intermediate Microsoft Office skills
• Works well individually and/or with a team setting.
• Deductive Reasoning
• Proficient in oral and written communication skills.
• Bilingual a plus.