Naperville, Illinois
Provider Relations Specialist Job Opening in Naperville, Illinois - Position Summary
The Specialist of Provider Relations assists with privileging and credentialing of hearing care providers. Insuring processes are timely and accurate. They will support the team in communication between the Field and provider Privileging and Credentialing through the onboarding process. Support in Maintaining updates and system records in the credentialing systems utilized. Assist in Collaboration with Human Resources through the hiring process, provides feedback on external vendor background check performance, and develops third party insurance relationships to facilitate the credentialing process. Works with the Central Business Office (CBO) to identify and/or resolve credentialing related denials and assures payors have current roster information to prevent denials.
Responsibilities & Duties
Processes privileging and credentialing paperwork or electronic submissions for new providers and recertification of current providers.
Responds to Support Center or Field communications regarding new providers privileging status, credentialing status, recredentialing, and licensing status.
Act as liaison communicating privileging, licensing, and credentialing information between Connect Hearing Support Center, Operation, and Field Teams.
Submits credentialing paperwork, rosters, recredentialing information to third party payors, networks, and government programs timely and accurately to minimize impact on patient flow.
Acts as liaison with third party payors to validate and/or correct entity and or provider set-up in the third party payors? system ensuring alignment with corporate strategy and the credentialing packet submission.
Tracks and logs status on assigned credentialing projects and open items to completion.
Builds and maintains professional relationships with internal and external customers.
Supports Hearing Care Center acquisitions and system implementations as needed.
Completes special projects as assigned by department manager or executive management.
Operates in compliance with all local, state and Federal laws as well as Company policy and compliance standards
Performs other duties as assigned.
Job Qualifications
Education:
High School Diploma or GED required, Associates Degree in healthcare administration, human resources, or related field preferred.
Certification(s):
None
Industry/Product Knowledge:
Familiarity with Privileging and or credentialing standards and procedures preferred
Skills/Abilities:
Advanced user of Microsoft Excel, Word, and PowerPoint
Superb attention to detail with ability to complete provider records
Strong verbal communication, written communication, and diplomacy skills
Analytical and problem solving skills
Interpersonal skills: Self-directed, motivated, and collaborative
Work Experience:
Credentialing or provider relations; and or
CBO third party follow up in accounts receivable (1500 forms)
Job Type: Full-time
Required education:
High school or equivalent
Required experience:
Provider Relations: 2 years
Credentialing: 2 years
Medical Insurance Knowledge: 2 years
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