Provider Maintenance Supervisor Job New York New York USA,Healthcare

Position Overview

This position directly interfaces with the Claims, Provider Network Operations, UM, IT, Credentialing, and Provider Contracting Departments as well as internal/external customers. The incumbent will provide day-to-day supervision of staff and must be able to perform all Provider Maintenance Representative functions as needed.

Scope of Role & Responsibilities

Document departmental policies and procedures.
Create/modify departmental user manuals.
Monitor staff performance including performance reviews.
Assist in resolving escalated provider participation issues from the Manager of Provider Maintenance and senior management.
Working closely with the Core Systems and Claims teams as well as SS&C. The incumbent will modify existing data to reflect updated provider information as needed.
Determine the impact of requested changes to the providers and claims
Assist requestor in determining the specifics of a given provider change request and assist and update to fulfill request.
Plan and implement procedures and systems to maximize operating efficiency
Address escalated inquiries from the Claims, Provider Network Operations, UM, IT, Credentialing, and Provider Contracting Departments as well as internal/external customers.
Address daily emails received from internal and external customers.
Assist in the 1099 reporting process
Assist in Med Home/Uploads/Communication Grid updates, when needed
Monitor and track activities related to the contract load process
Perform system testing as it relates to claims processing and provider setup
Develop processes as needed.

Required Education, Training & Professional Experience

Bachelor’s Degree; and
Minimum 2 years’ relevant supervisory experience required; or
A satisfactory equivalent combination of education, training, and experience Docusign Envelope : D4377095-C3F7-84DF-802F-CE
Knowledge of Health Rules Payor (HRP), Word, Excel, and Access preferred

Professional Competencies

Integrity and Trust
Customer Focus
Functional/Technical skills
Excellent oral and written communication skills.
Analytical and problem-solving abilities.

#MPH
50

#LI-Hybrid