Provider Maintenance Supervisor
Job Ref: TE0226
Category: Information Technology
Department: INFORMATION TECHNOLOGY
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $70,677.00 - $76,677.00
Position Overview
This position directly interfaces with the Claims, Provider Network Operations, UM, IT, Credentialing, and ProviderContracting 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 MedHome/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 ID: D4377095-C3F7-84DF-802F-C2C26D6249CE
- 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.
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