PE-Provider Services
This hybrid role focuses on healthcare provider services with an emphasis on claims adjudication and provider enrollment. You will analyze claims adjudication processes to identify improvement areas, implement effective solutions, and collaborate with cross-functional teams to streamline operations. Key responsibilities include managing claims data for accuracy, verifying provider credentials, maintaining up-to-date enrollment records, and monitoring claims processing for regulatory compliance. You will generate timely reports on adjudication outcomes for stakeholders, engage directly with providers to resolve claims and enrollment inquiries, and contribute to developing training materials for the provider services team. The position also involves supporting continuous improvement initiatives and implementing best practices to minimize errors and enhance service quality. Night shift availability is required.
