AvMed
Provider Network & Service Coordinator
This job is now closed
Job Description
- Req#: PROVI008976
- Conduct all provider in-house services to include:
- Provider education and outreach
- Compile all claim-related escalation issues and conduct the appropriate research, submission, and follow-up with provider
- Inform organization of provider participation status
- Handle escalated service forms from Member Services/Provider Service Center
- Provider Interest Form (PIF) Management
- Work the Provider Interest and Service form queues, conduct applicable research, seek resolution, and communicate accordingly
- Issue all pre-approved provider communications relative to the contract life cycle, service, and special events
- Prepare contract packets and onboarding materials packets
- Conduct provider adds, demographic changes, updates, and terminations. These processes may include:
- Requesting and compiling lists of member/group impacted by the change/termination
- Work needed to support member re-assignments
- Work in support of member letter generation process
- Audit systems containing provider data for accuracy of provider network information
- Prepare and provide inputs necessary for credentialing, configuration, and providing status of contract implementation process across the organization
- Enter related data into applicable systems
- Coordinate and manage the LOA process; ensure LOAs are loaded timely and accurately
- Ensure monthly receipt of delegated provider rosters; review rosters for accuracy and initiate steps to update the various systems with the applicable updates. Conduct audit to ensure changes were implemented.
- Review the delegated provider rosters for any participants in the exclusion and preclusion reports. Report any findings.
- Performs additional duties and responsibilities as assigned by management
- Competitive Salaries
- Comprehensive Benefits: Medical Plans, Health Savings Account, Dental, Vision, and more…
- Paid Time Off, Company Paid Holidays, Paid Time Off Cash-In
- 401(k)plan with matching contributions, Tuition Assistance, Associate Discounts
- High School Diploma required
- Bachelor's in business administration or healthcare related field, preferred
- 0-2 years in a Health plan experience within provider network contracting and/or service.
- Years of experience may sufficient in lieu of the minimum education required.
- Excellent verbal and written communication skills
- Proficient in Microsoft Word, Outlook, Excel, and PowerPoint
- Able to create comprehensive Excel data spreadsheets, work with Excel formulas, and create reports
- Proficient in Microsoft Windows environment
- Knowledge of health plan provider networks, HMO provider networks
- Basic claims payment system knowledge
- Possesses strong organizational skills
Embrace better opportunities.
Are you passionate about health, happiness and helping others? So are we. We’re committed to helping our health plan Members live a happy and healthy lifestyle, and we believe that it starts here first, with our Associates.
At AvMed, we provide the tools and opportunities to enhance, expand, and support each Associate’s personal and professional growth. From tuition reimbursement to exercise classes in the office, embrace a better career with AvMed and join our team!
Position: Provider Network & Service Coordinator
S cope of position: The Provider Network and Service Coordinator will be responsible for the servicing of Primary Care Physicians, Specialists, Ancillary Providers, Facilities, Delegated Entities, Benefit Vendors and Value Based Arrangements in support of AvMed’s strategic initiatives. The Provider Network & Service Coordinator will be service driven and, at all times, exemplify AvMed values of collaboration, respect, ethics, and accountability.
Essential Job Functions:
Review provider directory content and provide corrections
We Offer:
You have:
You May Also Have:
Environment:
At AvMed, you will find a family. Our Associates love all the opportunities for advancement, the flexible work environment and team activities. We also encourage our Associates to embrace a life rich in what matters most — health and happiness. We call it being WELLfluent. Join AvMed. Join the WELLfluent!
Location: Doral, Florida
This position is Hybrid 2 days in office and 3 days remote
AvMed is a tobacco/drug free workplace, EOE
About the company
AvMed offers health insurance coverage across Florida, including employer group plans, individual and family plans, subsidy-eligible and Medicare plans.