Provider Management Specialist Under direct supervision, work within and across department teams to maintain the configuration of providers, locations, groups, plans and benefit limits in the managing system. Ensure accurate and timely completion of production tickets assigned to ensure client satisfaction and retention. Support provider management activities associated with provider data maintenance, credentialing activities, directory management and intake requests. Research, resolve, document and accurately respond to provider, practice, business partner or administrator inquires and service requests. Communicate and coordinate with providers, practices and other departments to ensure accurate information is available to support business needs. Add and update Benefits Limits, Groups, Plans, new providers, and new locations in system. Upload fee schedules to applicable systems. Responsible for accurate set up of direct deposits. Configure and provide appropriate web portal access to clients. Timely and accurately generate and deliver reports as requested. Responsible for new business configuration setups following established processes/protocols. Ensure requested information is delivered within specified timeframe and completed accurately. Maintain high standards in all written or verbal communications with providers. Job Specifications Typically has the following skills or abilities: Two years of experience in health insurance information and data management systems. Strong understanding of health plan terminology. Computer proficiency, including Microsoft Excel and other MS Office tools. Strong analytical and critical thinking skills. Ability to read and write at a level necessary to accomplish the above tasks. Demonstrated ability to identify problems and provide creative solutions. Strong attention to detail, organizational skills and problem solving skills. Highly motivated and reliable individual with a strong sense of urgency; ability to meet tight deadlines. Excellent written and verbal communication skills. Ability to work independently and in a team environment. The working environment is generally favorable, lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc. The above information on this description had been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job range. Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services. Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
