Provider Contracting & Credentialing Specialist

Socket.dev; Miami (FL); On-site; USD 42,000 - 60,000; Full time

Job summary

Socket.dev is seeking a detail-oriented professional to support the Contracting and Credentialing Department's provider onboarding and documentation processes. You will coordinate provider submissions, load provider data, and liaise with health plan partners to ensure timely credentialing.

Responsibilities include researching providers, sending documents, and updating CRM (Monday.com) to reflect progress. A minimum 1 year in customer service or healthcare is required; an associate degree is

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.
• 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.

Skills

Problem solving

Microsoft Office

Teamwork

Deductive reasoning

Oral & written communication

Bilingual a plus

Monday.com

Credentialing system

Education

Associate degree or equivalent

Tools

Monday.com

Credentialing system

Job description

Socket.dev is seeking a detail-oriented professional to support the Contracting and Credentialing Department's provider onboarding and documentation processes. You will coordinate provider submissions, load provider data, and liaise with health plan partners to ensure timely credentialing.

Responsibilities include researching providers, sending documents, and updating CRM (Monday.com) to reflect progress. A minimum 1 year in customer service or healthcare is required; an associate degree is