Provider Servicing Coordinator

Provider Network Solutions, LLC; Miami (FL); Hybrid; USD 42,000 - 63,000; Full time

Job summary

Provider Network Solutions, LLC in Miami, Florida is seeking a detail‑oriented professional to support the Provider Servicing Manager by handling inbound inquiries from groups, providers, hospitals, and health plan partners, and by helping resolve issues. You will coordinate group submissions and paperwork, audit documents, update demographics, liaise with plans, and assist with special projects.

A strong communicator with problem‑solving skills and at least 1 year in customer service or claims

Qualifications

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

Responsibilities

• Supports the Provider Servicing Manager to achieve department goals.
• Answers incoming telephone inquiries from groups/providers/hospitals and assists with problem resolution of issues.
• Coordinates network group submissions, such as, group updates, monthly rosters, group applications and group listings to internal departments and external customers (i.e. health plan partners, PCPs and network groups).
• Provides oversight on inquiries and claims issues following up with respective internal departments and network groups to ensure issues and/or needs have been resolved.
• Reviews and processes incoming and outgoing paperwork for existing groups and network update email request and all other related functions.
• Liaison for all health plans in conjunction with the Provider Servicing Specialist.
• Audits all group-submitted requests, associated documents, and files according to Policies and Procedures for all health plans.
• Configures group loads on active group updates and enters all updates into databases.
• Performs batch processes for contract terminations, location terminations and new group location requests.
• Bi-Monthly Group Attestations and Quarterly expiration reports management.
• Sends required provider notification and letters via email, fax, or certified mail.
• Liaison between Groups to provide Servicing and Contracting detailed information requested.
• Special Projects as assigned or directed.

Skills

problem-solving

communication

deductive reasoning

teamwork

microsoft office

bilingual a plus

Education

Associate’s degree preferred

Job description

Position Summary

Supports the Provider Servicing Manager to achieve department goals. Answers incoming telephone inquiries from groups/providers/hospitals and assists with problem resolution of issues. Coordinates network group submissions, such as, group updates, monthly rosters, group applications and group listings to internal departments and external customers (i.e. health plan partners, PCPs and network groups).

Duties and Responsibilities

• Supports the Provider Servicing Specialist with all network group inquires.
• Provides oversight on inquiries and claims issues following up with respective internal departments and network groups to ensure issues and/or needs have been resolved. Providing Internal departments with any paperwork needed to take care of claims issues. Responds to Network groups and/or health plan partners to close the loop on any inquiries, issues and/or open items.
• Reviews and processes incoming and outgoing paperwork for existing groups and network update email request and all other related functions in accordance with the department’s Policies and Procedures.
• Liaison, in conjunction with the Provider Servicing Specialist, for all health plans.
• Audits all group-submitted requests, associated documents, and files according to the department’s Policies and Procedures for all health plans.
• Configures group loads on active group updates such as demographic changes, terminations, new lines of business, reimbursement changes, etc. and enters all updates into networks proprietary database and TPA database.
• Performs BatchGeo for all contract terminations, location terminations and new group location request in accordance with the department’s Policies and Procedures.
• Bi-Monthly Group Attestations sent and ensured they are received back signed by groups. This is mandatory to obtain and store in Networks proprietary database.
• Quarterly expiration reports check to ensure that all expired documents for groups are received within the quarter and stored in networks proprietary database.
• Sends via email, fax blast and/or certified mail required provider notification and letters.
• Liaison between Groups to provide Servicing and Contracting detailed information requested.
• Special Projects as assigned or directed.

Requirements

Knowledge

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

Skills

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