About the position
The Provider Network Coordinator at Arkansas Blue Cross and Blue Shield plays a crucial role in guiding and assisting a team of provider network specialists. This position is responsible for making day-to-day operational decisions related to provider enrollment, credentialing, and contracting activities. The incumbent will analyze, develop, and recommend solutions to network problems and changes in network strategies, ensuring that the provider network operates efficiently and effectively. In this role, the Coordinator will conduct audits to authenticate the validity of various operational outcomes and will be involved in problem-solving by researching and investigating audit findings to determine root causes. The Coordinator will also participate in special projects as requested and conduct quality audits to ensure compliance with performance standards, including quality, accuracy, and timeliness. This includes reviewing work standards, providing feedback, and defining sample sizes for quality assurance. Additionally, the Coordinator will maintain compliant reporting and documentation of all quality results, track and analyze audit findings for process improvement opportunities, and identify compliance issues according to program requirements. The role also involves assisting with testing, verification, documentation, and implementation of system changes to ensure proper functionality. Training and supporting team development by identifying training needs and knowledge gaps is also a key responsibility of this position.
Responsibilities
- Provide guidance and assistance to a team of provider network specialists.
- Make day-to-day operational decisions in provider enrollment, credentialing, and contracting activities.
- Analyze, develop, and recommend solutions to network problems and changes in network strategies.
- Conduct audits to authenticate the validity of operational outcomes.
- Research and investigate audit findings to determine root causes and identify trends impacting service levels.
- Participate in special projects as requested.
- Conduct quality audits and analysis ensuring compliance with performance standards.
- Maintain compliant reporting and documentation of quality results; track, trend, and analyze audit findings.
- Assist with testing, verification, documentation, and implementation of system changes.
- Support team development by identifying training needs and knowledge gaps.
Requirements
- Bachelor's degree or five (5) years' health-related non-clerical experience with an insurance, managed care, or healthcare organization.
- Minimum three (3) years' experience in healthcare and/or health insurance related to provider relations, provider contracting, provider credentialing, claims administration, and/or office management.
- Physician Credentialing Certification preferred.
- Proficiency in MS Office Suite, including Word, Access, Excel, PowerPoint, and Adobe.
- Strong decision-making and problem analysis skills.
- Excellent oral and written communication skills.
Nice-to-haves
- Experience in claims administration.
- Knowledge of medical terminology.
- Skills in change management and team mentoring.
Benefits
- Tuition reimbursement.
- Access to Club Blue, a free onsite gym.
- Onsite restaurants promoting healthy eating.
- Incentives for wellness education and exercise.
