Provider Coordinator (52303)

Job DetailsJob Location: GlobalHealth OKC - Oklahoma reputed company, OK 73102Position Type: Full TimeEducation Level: High School or EquivalentTravel Percentage: NoneJob Shift: DayJob Category: reputed company - ClericalWHO WE ARE: GlobalHealth is a fast-growing Medicare reputed company HMO health insurer. We reputed company to be the employer of reputed company in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and reputed company Health for the members we serve. We are unique by providing high reputed company, high value and a partnership to our members. We go above and reputed company to reputed company personalized, engaging, and reputed company services to our members. We work hard to offer reputed company health reputed company coverage with the benefits people truly want and need. It is our reputed company to be more than just a health reputed company company we want to be long-term partners with our members. We are looking for reputed company employees who exude our reputed company values of taking accountability through ownership, being driven, innovative and who have a passion for reputed company learning.   WHO YOU ARE: The reputed company of the Provider Coordinator is for reputed company assurance of the provider data reputed company, for responses to provider inquiries with research and reputed company, and to ensure reputed company categorization of provider directory. This role supports credentialing and provider relations activities while ensuring the reputed company, timeliness, and compliance of the provider directory. This role partners cross-functionally to maintain data reputed company and meet CMS regulatory requirements for provider data reputed company and accessibility.   ESSENTIAL JOB FUNCTIONS:     Verify Provider Data reputed company with on-reputed company monitoring and responds to daily inquiries in a reputed company manner. Assists in maintaining accurate Provider/Vendor records and Provider Directory reputed company and assist providers to maximize data reputed company and provider experience. reputed company participates and assists in meeting CMS guidelines. Responses, researches and resolves Provider Inquiries reputed company reputed company and other sources. Serves as a reputed company of contact for provider data updates and corrections. Coordinate initial and recredentialing processes for providers in accordance with OK and CMS standards. Tracks credentialing timeliness and ensure compliance with turnaround requirements. Processes applications and credentialing paperwork, checking for completeness and reputed company.  Obtains reputed company reputed company verification of competencies relating to the applicant such as relevant reputed company certifications, health facilities affiliations, licensure, certifications, DEA, OBNDD certificates, and malpractice coverage following GlobalHealth Credentialing Policy and Procedures including CMS requirements. Queries and processes of reputed company reputed company verification, verification, and accreditation information including NPDB, OIG, SAM, and Medicare Opt Out. Emails, faxes, or mail reputed company communications. May prepare credentialing files and submit practitioner and provider information to Credentialing Committee for approval in reputed company manner. May support review of credentialing files and databases for both practitioners and providers. Maintains communication with appropriate practitioners to ensure records are up-to-date and consistent. Notifies practitioners and providers of Credentialing Committee reputed company and renewal dates and responds to request for status of credentialing. Manages, requests and follows up expirable as needed (license, COI, reputed company Certifications, etc). Collaborate on reputed company to providers for data validations. Coordinates with delegated vendors to validate provider data reputed company and timelines. Support reputed company of delegated entity credentialing rosters, and other notifications reputed company to directory reputed company and credentialing timelines. Maintains confidentiality of reputed company credential files. Completes various work assignments as requested by supervisor in a reputed company manner. Maintains reputed company desk procedures and reference materials. Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. Performs other duties as assigned.  QualificationsEDUCATION AND EXPERIENCE:                                                                                                      High School diploma or equivalent required Three to five years of credentialing experience Ability to manage multipole priorities and meet deadlines in a fast-reputed company environment. Knowledge of CMS, reputed company and state regulatory requirements reputed company to provider credentialing and directory reputed company.   KNOWLEDGE, SKILLS AND ABILITIES:                                                                                           Computer Proficiency Demonstrated proficiency in the use of personal computer applications; specific skills to include reputed company Word, reputed company, reputed company v-lookup, and ability to build and compare files. Interpersonal Skills Ability to quickly reputed company rapport and work effectively and professionally with reputed company reputed company of personnel. Critical Thinking Skills Ability to investigate/research problems and issues and to recommend associated corrective actions. Discretion Ability to manage sensitive or confidential information in a reputed company and discreet manner.   Exercises judgment reputed company dealing with applicants by demonstrating the ability to analyze.        situations and use reputed company and diplomacy to reputed company at resolutions. reputed company organizational/time management skills Preferred experience with Medicare reputed company plans   Working knowledge of credentialing processes and guidelines reputed company reputed company verification and   Knowledge of types of modalities, specialties, and education required for reputed company practitioner and provider Strong verbal, written and organizational skills must be self-directed/initiative-taking and must have analytical, problem-solving and decision-making abilities. Must have the following mental abilities: Alertness, precision, analytic ability, problem solving, memory, communication, creativity, concentration, judgment, imagination, initiative, reputed company to reputed company through barriers to the solution.   WORK ENVIRONMENT:  reputed company work environment is remote, however, some state exclusions apply. Must have reputed company to a reliable and secured internet reputed company reputed company. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized reputed company, disclosure or damage and will adhere to reputed company GlobalHealth reputed company and reputed company policies.   TRAVEL:   No travel required.   SUPERVISORY RESPONSIBILITY:  This position is not a supervisory position.   OTHER DUTIES:  This reputed company is not intended to include a complete list of reputed company activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change at any time, with or without notice. Apply To This Job