Provider Management Specialist

3 months ago
Requisition ID
2017-2055
# of Openings
1
Area of Interest
Administration
Company
Elderwood
Elderwood Administrative Services
Position Type
Regular Full-Time

Overview

The Provider Management Specialist is responsible for researching and credentialing new providers while maintaining current relationships and contract files. Provider Management Specialist will assist Executive Director with special projects as needed.

Responsibilities

  • Perform credentialing for Elderwood Health Plan vendors
  • Work with Provider Relations department on contract management
  • Research providers for network expansion and send written and electronic correspondence
  • Maintains confidentiality of all information
  • Ensure compliance with regulatory standards
  • Demonstrate knowledge and understanding of all policies and procedures and ability to reference them from appropriate books and manuals
  • Assist Executive Director with special projects as needed
  • All other duties as assigned

Qualifications

  • Associates degree required, Bachelors preferred
  • 3+ years experience in a managed care setting, medical office or facility setting with demonstration of medical administration duties
  • 2-5 years supervisory experience preferred
  • Prior medical insurance experience, training and claims processing preferred
  • Ability to travel to provider sites, conferences, etc.
  • Must be in good standing with the Medicare and Medicaid programs
  • Knowledge of contracts and revision process

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