Provider Operations Representative

Description and Requirements

The Provider Operations Representative is responsible for processing requests to terminate provider records and process panel transfers within MHS (Medical Health System) accordingly. Additionally, they provide operational support for Network Management, Regulatory, Member Services, Provider Services, Credentialing, Claims, Medical Management, and Enrollment to ensure that our Provider database and subsequent reporting is as up-to-date and accurate as possible.

This position is Remote

Job Description

• Conducting comprehensive and thorough review of requests for Provider profile set-up and/or updates initiated by other departments and received via Macess, fax, or e-mail for accuracy and completeness.
• Collaborating with internal and external customers to obtain any missing information required to complete requested set up and/or update.
• Entering Provider profile data into MHS database as requested.
• Identify inconsistencies and/or conflicts between Provider and Facility records.
• Validating Providers profile data for compliance with Provider set up guidelines as required to execute and file Providers application.
• Analyzing Provider records within MHS and compare the data against the initial set up instructions provided.
• Communicating discrepancies to both internal and external customers as appropriate to clarify and resolve any inconsistencies in order to ensure database accuracy.
• Maintaining a daily production sheet daily to include all work completed for the workday.
• Providing daily updates to Senior Representatives on the status of all active projects until completed.
• Managing work assigned through prioritization in order to meet expected completion deadlines for each request received.
• Communicating with department leadership to ensure that assigned workload can be completed as assigned.
• Participating in special projects as required.
• Additional duties as assigned.