|Interested? Email Us||Never Applied? Apply|
|Provider Relations/Network Operatio Representative|
|Hours:||40 Monday Friday 8AM to 5PM|
|Great opportunity in Camarillo CA|
A member of a cohesive unit that responds to and provides education to providers regarding health care programs. Responsible for maintaining a positive presence in the community. This position includes performing all activities related to provider data base management and internal provider relations functions. Ensure accuracy and timeliness of data entry of provider network data into the Provider Relations department software. Assist with the maintenance of all provider dataAssist Management with the network development team activities to produce timely and positive resultsProvide timely handling and completion of assigned projects. Provide regular and timely reports for all assigned projects. Improve the efficiency of the Network Operation process and procedures to enhance quality and efficiency Be able to respond to claims submission questions and have a good understanding of provider claims submissionsProvide timely and accurate submission al of all company requested projects, assignments and reportsCommunicate with telephonically with providers and their staffs to obtain and provide follow up informationBe Familiar with regulatory requirements around provider data reporting and apply to project workloadWork with providers to adhere to contract and regulatory requirements Data entry, audit, daily maintenance of the PR department master data Research, review and make updates to user requests within provider data management system Review provider setup and ensure all records are accurate Update provider and practitioners, facilities Hospitals and Clinics statusto par by adding claims payment informationwith all provider data management including contracted and non-contracted provider data and other software programs
HSGED. 3 yrs experience in the health care field interacting directly with providers. Good telephone demeanor. Must have previous experience with provider data, knowledge of medical terminology and medical providerpractitioner terminology.
Experience working with MediCal claims a plus.Associate Degree or certification in Healthcare processes a plus.