DUTIES AND RESPONSIBILITIES:
- Coordinate provider credentialing and re-credentialing processes in compliance and other regulatory standards.
- Maintain and update provider information in internal systems, directories, and member-facing platforms.
- Support provider contracting efforts, including documentation, renewals, and amendments.
- Act as a liaison between the company and healthcare providers to resolve issues related to network participation, claims, and billing.
- Monitor provider network adequacy to ensure sufficient coverage and access for members.
- Collaborate with claims, customer service, and compliance teams to support provider-related inquiries and investigations.
- Generate reports on provider performance, network gaps, and credentialing status for management.
- Stay current on industry regulations, accreditation standards, and best practices related to provider network management.
REQUIREMENTS:
- Bachelor’s degree in healthcare administration, business, or related field preferred.
- Experience in insurance provider network management, credentialing, or provider relations.
- Knowledge of healthcare insurance operations, provider contracting, and regulatory compliance.
- Strong communication, negotiation, and problem-solving skills.
- Detail-oriented with the ability to manage multiple priorities.
- Proficient in provider databases, credentialing software, and Microsoft Office Suite.
Job Types: Full-time, Permanent
Benefits:
- Additional leave
- Company events
- Flexible schedule
- Health insurance
- Life insurance
- Opportunities for promotion
- Promotion to permanent employee
- Work from home
Experience:
- Medical Insurance Business: 1 year (Preferred)
Work Location: In person