Shire Jobs

PRINCIPAL RESPONSIBILITIES:

The Provider Relations Coordinator, under general supervision from the Supervisor, Provider Relations will assist and work directly with the Provider Relations Representatives, and performs a variety of routine and semi-routine tasks requiring a thorough knowledge of organizational policies and procedures. This position will provide administrative and operational support for the Provider Relations Unit, especially Provider Relations Field Representatives.

Principal responsibilities include:

• Assist Provider Relations Field Representatives in administering their daily tasks including but not limited to assisting with the coordination of their scheduled appointments, claims reconciliations, maintenance of visit statistics and any other informational gathering projects as assigned.
• Assist Provider Representatives with basic inquiries about claims, authorizations, benefits, and other issues. This includes working in conjunction with the Health Care Services, Members Services and Claims departments.
• Provide administrative support to the Manager and Director, and to the other members of the Provider Services Department, as needed.
• Document provider inquiries and follow through with solutions in an accurate and timely manner.
• Effectively manage the Provider Portal Access and issue resolution processes.
• Timely manage and respond to requests that come to the Provider Services departmental inbox.
• Track and maintain files and electronic record of provider forms, prepare schedules, compile reports, and process documents of a routine nature in an accurate and timely fashion.
• Coordinate processing of incoming and outgoing mail.
• Provide administrative support in the following areas:
• Statistical Reports (monthly, quarterly, etc.)
• Provider Directories
• Provider Manual
• Provider Fax Blasts
• Provider Surveys
• Provider Meetings
• Complete other projects as assigned
• Assist with the maintainence of data within various databases.
• Print and distribute information on request.
• Participate in the Provider Relations Unit and other departmental projects and meetings, as needed.

ESSENTIAL FUNCTIONS OF THE JOB

• Office Duties - Including photocopying, faxing, emailing, and telephone coverage for providers
• Computer - Assisting in the maintenance of various databases to ensure integrity of data; word-processing; preparing and maintaining spreadsheets and/or Smartsheets.
• Coordinating and Preparing Outflow of Requested Mailings - Stamping, labeling, and occasional manual distributions.
• Mail - Receiving and distributing incoming and outgoing mail and controlling the internal flow of mail ensuring proper destination.
• Telephone - Receive and document telephone calls from providers and other staff as needed.
• Compliance - Complying with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Frequent use of telephone headset
• Frequent verbal and written communication with staff and other business associates by telephone, email, virtual platforms, correspondence, or in person.
• Frequent lifting of folders, files, binders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• High School diploma.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Minimum two years experience in managed care setting.
• Preferred managed care experience in areas of member (customer) Relations, claims payment, claims resolution, and/or provider Relations.

* PECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):*

• Strong customer service background.
• Excellent critical thinking and problem solving skills.
• Ability to work in a multidisciplinary company.
• Experience in use of computer software: MS Word, Excel, and PowerPoint.
• Ability to work in cooperation with others.
• Ability to communicate effectively, both verbally and in writing.
• Ability to handle multiple projects simultaneously and balance priorities as well as work for a number of individuals.

SALARY RANGE $26.07-$39.10 HOURLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.