Provider Servicing & Network Coordination Specialist

Provider Network Solutions, LLC; Miami (FL); On-site; USD 36,000 - 48,000; Full time

Job summary

Provider Network Solutions, LLC in Miami, FL is seeking a detail‑oriented service associate to support the Provider Servicing Manager with network group inquiries and problem resolution. This role coordinates group submissions, such as rosters, group applications, and listings to internal departments and health plan partners.

You will liaison with health plans, audit group documents, and manage updates in proprietary databases, ensuring timely, accurate processing and communication with PCPs and

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 Specialist with all network group inquiries.
• 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 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.

Job description

Provider Network Solutions, LLC in Miami, FL is seeking a detail‑oriented service associate to support the Provider Servicing Manager with network group inquiries and problem resolution. This role coordinates group submissions, such as rosters, group applications, and listings to internal departments and health plan partners.

You will liaison with health plans, audit group documents, and manage updates in proprietary databases, ensuring timely, accurate processing and communication with PCPs and