Job Description

Location: Steward Health Care Network
Posted Date: 2/6/2020

Steward Health Choice is dedicated to improving the health and well-being of the people and communities we serve.

Steward Health Choice believes in a personal approach to health care right in your community. We built our health care plan around you. Our goal is to give you quality health care, programs, and services to support you on your path to wellness.

Steward Health Choice provides exceptional customer service and culturally competent care through:

  • Compassionate and responsive member services team
  • Collaboration with community physicians to help members get the health care they need.
  • Providing culturally competent health care, including extensive translation and interpretation services
  • Health programs to help members and their families stay healthy

Position Purpose: Ensures all contracted and non-contracted provider demographics and payment methodologies are accurate and up to date within company systems and ensures the integrity and accuracy of provider demographic data.

Enters and maintains provider demographic information in company systems and applicable web interface programs that is received from each of the following sources: providers, network service representatives, Information Services Department staff, Network Services Department staff, Reimbursement Services Department staff, provider rosters, audit results and other sources. Makes corrections to errors as received. Keeps up to date on all information received, following and keeping within departmental data entry turnaround and accuracy standards. Scans and stores provider contracts and other documents in designated shared drive and software application sites.

Primary Accountabilities:

  • Downloads provider applications and reviews them for accuracy before they are submitted to the regional PDM and Credentialing Departments.
  • New provider demographics are entered within department guidelines, including all information for accuracy.
  • All provider demographic changes are entered within department guidelines, including all information for accuracy
  • Identification of missing information and informing requesting provider service representative.
  • Perform a variety of other duties as assigned

Downloads provider credentialing (CAQH) applications and checks them for accuracy. Follows up with providers in a timely manner to obtain missing and/or incorrect documentation. Participates on calls with regional PDM and Information Services Department staff to assist with troubleshooting and recommending enhancements to company systems and related programs. Tracks providers throughout the credentialing process to ensure that credentialing turnaround time frames as set by the Network Services and Credentialing Department leaders are maintained.

Primary Accountabilities:

  • Tracks providers throughout the credentialing process
  • Responds to requests for missing information in a timely manner
  • Assists Medical Director in achieving an efficient process for presenting completed credentialing files at the monthly Credentialing Committee.

Assists the Credentialing Department to prepare the agenda, organize handouts and other materials, and takes minutes at regularly scheduled Credentialing Committee as applicable. Interfaces with the market Medical Director and with Credentialing Department counterparts in the regional office to achieve a smooth credentialing process for providers. Helps facilitate the Medical Director and Credentialing Committee approval and denial notification processes (e.g., Welcome and Denial letters) with other Network Services Department staff. Promptly and accurately loads approved providers into company systems.

Primary Accountabilities:

  • Credentialing Agendas are accurate and timely
  • Minutes are completed in a timely manner
  • Interpersonal relationships with the Medical Director and Credentialing Department staff are effective and professional
  • Ensures providers are accurately loaded into company systems

Performs various other department duties as assigned

Education / Experience / Other Requirements

Education:

  • High school Diploma/GED is required.
  • College coursework and/or degree preferred

Years of Experience:

  • A minimum of one year of health plan experience is preferred

Work Related Experience:

  • Ability to accurately enter data in a deadline driven environment is required
  • Previous credentialing experience is preferred
  • Knowledge of the health care industry is preferred

Specialized Knowledge:

  • Organizational skills with a strict attention to detail
  • Interpersonal skills
  • Working knowledge of Microsoft Office
  • Ability to function well in a changing environment

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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