Provider Network & Credentialing Specialist

Health Care Service Corporation; Houston (TX); On-site; USD 48,000 - 86,000; Full time

Job summary

CareAllies is seeking a provider data specialist responsible for contracting, credentialing, and maintaining professional provider data to support marketing, membership and network contracting across all lines of business. Building relations with the provider community is an important part of this role.

As part of the Provider Engagement Team, this position will work closely with providers to accelerate their transition to value-based care and to help them manage the long-term health of their

Qualifications

• Bachelor degree OR 4 years of experience in the Health Care industry.
• 2 years of experience with Provider Network contracting and credentialing systems.
• Written and verbal communication skills to interact with internal and external customers.
• Analytical and quantitative skills.
• Ability to take initiative and work independently.
• Experience with Microsoft Office applications including Excel, Access, and Power Point.
• Previous HEDIS and CMS STARs experience.

Responsibilities

• Manage contracting, credentialing, and maintenance of provider data to support marketing and network contracting.
• Build relations with the provider community and promote data integrity initiatives.
• Provide operational and customer support duties requiring independent initiative.
• Participate in internal provider meetings and work groups; research credentialing and data issues.
• Develop and maintain relationships with physicians, providers, and practice managers.
• Provide tactical operations support including contracting, data integrity, communications, and relationship management.
• Create and deliver materials to educate providers on contracts, policies, and performance.
• Prepare and deliver presentations with providers and leadership during monthly meetings.
• Track and report program metrics (utilization, coding, STARs/quality).
• Perform root cause analyses related to provider concerns and claims.

Skills

Contracting experience

Credentialing systems

Communication skills

Analytical skills

Independent initiative

Team player

Education

Bachelor degree or equivalent (Health care)

Tools

Microsoft Excel

Microsoft Access

Microsoft PowerPoint

Pivot tables

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Job description

CareAllies is seeking a provider data specialist responsible for contracting, credentialing, and maintaining professional provider data to support marketing, membership and network contracting across all lines of business. Building relations with the provider community is an important part of this role.

As part of the Provider Engagement Team, this position will work closely with providers to accelerate their transition to value-based care and to help them manage the long-term health of their