Provider Network Coordinator

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.

Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.Arkansas Blue Cross is only seeking applicants for remote positions from the following states:Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

Job SummaryThe Provider Network Coordinator provides guidance and assists to a team of provider network specialists. The incumbent makes day-to-day operations decisions in areas of provider enrollment, credentialing, and contracting activities. The incumbent also analyzes, develops, and recommends solutions to network problems and changes in network strategies.

Requirements

EDUCATION

Bachelor’s degree. In lieu of degree, five (5) years' health related non-clerical experience with an insurance, managed care, or healthcare related organization will be considered.

LICENSING/CERTIFICATION

Physician Credentialing Certification preferred.

EXPERIENCE

Minimum three (3) years' experience in healthcare and/or health insurance related to provider relations, provider contracting, provider credentialing, claims administration, and/or office manager/administrator.

ESSENTIAL SKILLS & ABILITIES

Decision Making
Problem Analysis
Medical Terminology
Claims Administration
Oral & Written Communication
Change Management
Team Mentoring

Proficiency working with MS Office Suite, such as Word, Access, Excel, PowerPoint and Adobe.

SkillsAnalytical, Change Management, Decision Making, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Oral Communications, Written Communication

ResponsibilitiesAudit: May be required to authenticate the validity of a variety of operational audit outcomes to external parties., Other duties as required., Problem Solving: Conducts research and investigation on all audit findings to determine the root cause; Identifies developing trends impacting service levels and proactively partners with appropriate parties to recommend solutions., Projects: Participates in special projects, as requested, Quality Assurance: Conducts quality audits and analysis ensuring compliance with performance standards (e.g. quality, accuracy and timeliness), which includes reviewing work standards, giving feedback and/or defining sample size., Reporting: Maintains compliant reporting and documentation of all quality results; track, trend and analyze audit findings for process improvement opportunities, identify compliance issues according to program requirements, and creates appropriate reporting., Testing: Assist with testing, verification, documentation and implementation of systems errors, changes, and enhancements to ensure proper system functionality., Training: Support team development by identifying training needs and knowledge gaps. Aid in the development and maintenance of documentation. Also assist with training and coaching sessions.

Certifications

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment TypeRegular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.