Network Service Claims Specialist (Credentialing and Data Entry)

WHAT’S THE FORMAL TITLE?

Network Service Claims Specialist (Credentialing and Data Entry)

 

WHAT’S THE REAL TITLE?

Enigmatologist - someone involved in the science of puzzles of any kind, be they mathematical, word or logic-oriented. 

 

WHAT’S YOUR MOTTO?

Ordo ab Chao (Latin): Order from Chaos

 

WHY IS THIS ROLE CRITICAL?

This position will manage the information flow between our credentialing vendor and Imagine Health, which is critical to the success of our company.

 

WHAT IS A DAY IN THE LIFE?

As the lead in charge of all communication between Imagine and our credentialing vendor, you will track down all information necessary for credentialing and updating provider information in our databases.  You will be a strong team player and work with the Network Contracting team to help ensure we have the right information for successful credentialing.  You will need to understand concepts related to medical provider networks, have a good understanding of the credentialing process, and be detail oriented.  You’ll answer phone calls from Imagine’s customers and in doing so, help members find physicians and help medical offices verify benefits and eligibility.  

 

OK, HOW ABOUT SOME SPECIFIC RESPONSIBILITIES?

  • Work within established parameters to maintain proper data flow of credentialing information between Imagine Health and our credentialing vendor
  • Contact physician offices as needed to retrieve missing information for credentialing
  • Function as part of data entry team to keep provider information accurate and up to date
  • Provide phone support for members, TPAs and providers, and answer questions related to network status, benefit guidance, etc.
  • Take on other duties as needed

WHAT TYPE OF THINGS HELP ME THRIVE IN THIS ROLE?

  • Associate’s Degree or equivalent experience
  • 2+ years of experience working in a healthcare support environment is preferred
  • Experience in a provider relations or credentialing type role either with a health plan or medical office
  • Experience/knowledge about concepts of medical networks
  • Experience managing vendor relationships
  • Intermediate skill in using Microsoft Office products, especially Excel, Access, Word
  • Database experience is a plus
  • Highly self-motivated and accountable
  • Excellent verbal and written communication skills
  • Exceptional interpersonal and organizational skills
  • Enjoys improving processes and thinking critically

 

Does this sound like you? Send us a resume!

Rick Abbott1 Comment