Provider Maintenance Supervisor

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
• 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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