Healthcare Contracting & Credentialing Specialist

Provider Network Solutions LLC; Miami (FL); On-site; USD 38,000 - 54,000; Full time

Job summary

Provider Network Solutions LLC in Miami, FL is seeking a Contracting and Credentialing Support professional to assist the department’s submitting provider applications, network agreements, and related documentation to internal systems and partners.

You will research provider information, handle mailings and communications, support field teams, and ensure accurate processing of credentialing packets while maintaining CRM updates.

Qualifications

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

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.
• Configures 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.

Skills

Problem solving

Microsoft Office

Teamwork

Deductive reasoning

Communication

Bilingual

Education

Associate degree or equivalent

Tools

Monday.com

Credentialing systems

Job description

Provider Network Solutions LLC in Miami, FL is seeking a Contracting and Credentialing Support professional to assist the department’s submitting provider applications, network agreements, and related documentation to internal systems and partners.

You will research provider information, handle mailings and communications, support field teams, and ensure accurate processing of credentialing packets while maintaining CRM updates.