Provider Relations Specialist


Job Type

Full Time

Published:

04/11/2018

Address

330 West 42nd Street
New York
New York
10036
United States

Description

The 1199SEIU Benefit & Pension Funds provide comprehensive health, pension, and quality of life benefits to unionized workers represented by 1199SEIU United Healthcare Workers East. We are among the largest labor-management funds in the nation, covering 400,000 members and their families.


If you’re ready for the brightest career future, join us in this excellent opportunity to showcase your talents. We are currently seeking an experienced Provider Relations Specialist for our Provider Relations department. 


Responsibilities:


  • Perform primary provider source verifications of license, Drug Enforcement Administration (DEA) number, hospital affiliation, board certification status, malpractice history and sanction activity through various web-based agencies and sources
  • Research and summarize provider’s malpractice history for Credentialing Committee review
  • Enter and review provider information in Trinity system; prepare reports as needed
  • Confirm authenticity of documents and ensure pre-established criteria has been met; return provider applications that do not meet criteria
  • Verify and review provider applications, participation agreements or designations of provider groups for completion
  • Follow up with providers or office managers in regards to missing or expired information in the credentialing application or documentation
  • Check provider status files for duplication and possible conflicting information
  • Perform statistical analysis via Excel spreadsheet
  • Perform additional duties and projects as assigned by management
  • Must meet performance standards including attendance and punctuality


Qualifications:


  • High School Diploma or GED required, some College or Degree preferred
  • Minimum two (2) years administrative experience in a general office environment required and two (2) years credentialing experience in a managed care or medical environment preferred
  • Experience with Provider Relations’ practices, business processes and credentialing databases (i.e. Cactus) preferred
  • Basic skill level in Microsoft Word and Excel required
  • Excellent interpersonal and communications skills - both written and verbal
  • Strong analytical, problem-solving, time management, planning and organizational skills
  • Must possess excellent critical thinking and analytical capabilities; excellent attention to detail and accuracy
  • Ability to work well under pressure to meet deadlines and able to multi-task effectively and follow through on assignments to completion
  • Must be able to work well independently with minimal supervision, able to exercise good judgment and be a team player
  • Must be able to effectively handle sensitive and confidential situations with integrity, tact, and diplomacy
  • Ability to establish and maintain effective working relationships with providers, staff, and other agencies; provide a positive service attitude when dealing with internal and external customers

Benefits

medical, dental, Rx, 401k tuition reimbursement, no copay

Professional Level

Entry level

Minimum Education Required

High School

How To Apply

http://chm.tbe.taleo.net/chm03/ats/careers/requisition.jsp?org=NBF1199&cws=1&rid=7083

We offer a competitive salary, an excellent fully employer-paid comprehensive benefits package and talented professional colleagues. For consideration and to apply, please visit us at http://chm.tbe.taleo.net/chm03/ats/careers/requisition.jsp?org=NBF1199&cws=1&rid=7083. Please mention you saw this ad in Idealist. We are an Equal Opportunity Employer.


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