Provider Operations Coordinator

Unclassified - Fort Lauderdale, FL

Full-time

Remote - Fort Lauderdale, FL

About the position

The Provider Operations Coordinator plays a crucial role in ensuring that healthcare providers are accurately set up in the provider information system, which is essential for state reporting, claims payment, and maintaining directories. This position involves a variety of responsibilities that contribute to the smooth operation of the Provider Operations Department. The coordinator will be responsible for managing multiple state deliverables, network reporting, and resolving claims payment issues related to provider setups. In addition to these core responsibilities, the Provider Operations Coordinator will conduct annual after-hours provider surveys as mandated by the agency and the Florida Healthy Kids Corporation. They will also manage and maintain the Customer Relations Management (CRM) pool, ensuring compliance with all relevant regulations from the Agency Health Care Administration, Department of Insurance, and Centers for Medicare and Medicaid Services. The coordinator will assist with out-of-network negotiations and provide exceptional customer service by answering the Provider Hotline and addressing inquiries from providers. The role requires effective communication and collaboration with various departments, including Claims, Care Coordination, Customer Experience, and Utilization Management. The coordinator will assist Provider Operations Representatives and Contract Negotiators in investigating and resolving provider issues, as well as handling all provider-related correspondence, including mail, email, and fax. They will also coordinate the completion of credentialing applications for providers, conduct internal directory audits, and educate providers on policies and procedures related to referrals and claims submission. This position may also involve performing other duties as assigned by management.

Responsibilities

• Ensure providers are accurately set up in the provider information system for state reporting, claims payment, and directories.
• Conduct annual after-hours provider surveys as mandated by the agency and Florida Healthy Kids Corporation.
• Manage and maintain the Customer Relations Management (CRM) pool.
• Abide by compliance requirements for the Agency Health Care Administration, Department of Insurance, and Centers for Medicare and Medicaid Services.
• Assist with out-of-network negotiations.
• Answer the Provider Hotline and provide optimal customer service to all callers.
• Report and maintain history of all telephone encounters and inquiries raised by providers.
• Act as an inter-departmental liaison for Claims, Care Coordination, Customer Experience, and Utilization Management departments.
• Assist Provider Operations Representatives and Contract Negotiators with investigation and resolution of provider issues.
• Receive and process all provider-related mail/email/fax, including address changes and claim reconsiderations.
• Assist in the coordination of completing the credentialing application for providers.
• Complete internal directory audits and develop provider notices via fax/email blast.
• Educate providers regarding policies and procedures related to referrals and claims submission.

Requirements

• Associate's degree or equivalent experience required.
• 2-3 years of customer service experience preferred.
• Provider relations experience preferred.
• Knowledge of Microsoft Word and Excel is required.
• Strong verbal and written communication skills.
• Detail-oriented with the ability to work independently in a fast-changing environment.
• Excellent time management skills and ability to manage multiple priorities.

Nice-to-haves

• Experience in healthcare provider relations.
• Familiarity with compliance regulations in healthcare.

Benefits

• Work from home 3 days a week and report to the office 2 days a week.