Performs a wide variety of administrative duties to support the Provider Operations Department. Assists department management and other staff with provider Data Management, Network Configuration, provider credentialing, contract implementation, correspondence, and information updates. Works under moderate supervision.
- Maintains current provider demographic information in databases (Salesforce, Facets, Guiding Care) via data entry. Works with vendors to ensure data consistency and quality.
- Works system errors and exceptions to maintain clean provider data across all systems.
- Facilitates outreach to providers to test integrity of online provider demographic information. Updates provider data as needed to ensure quality.
- Monitors updates for provider data intake pathways, including but not limited to, Portal, Online form, mail, fax and email. Coordinates with providers and updates record accordingly
- Assists with Claim intake, and creates out of network profiles as necessary.
- Interfaces internally to investigate provider issues and assist with customer resolution.
- Processes return mail and return checks; logs data and updates provider record to remediate return mail.
- Monitors and resolves Provider Claim Pend queue. Escalates issues as appropriate.
- Obtains required documentation from providers necessary for the establishment of a complete provider record on VNSNY systems, e.g. IRS W9 form.
- Provides administrative support to the department including filing, mail distribution, preparing reports, and documenting inquiries and requests.
- Participates in special projects and performs other duties as assigned.
Education: Bachelor's Degree in Business, Communications or related field or the equivalent work experience required.
Experience: Minimum two years experience in health care Payer environment required, Credentialing or Provider Data. Excellent written/oral communication and interpersonal skills required. Proficient in Microsoft Office Applications, including Excel, required. Experience in administering provider relationships preferred.
The Visiting Nurse Service of New York (VNSNY) is one of the nation's largest not-for-profit home- and community-based health care organizations, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Counties. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost-effective health care in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, health plan members, and clients from before birth to the end of life. On any given day, VNSNY employees - including nurses, rehabilitation therapists, social workers, home health aides and other professionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to approximately 40,000 individuals in our care helping them to live the best lives possible in their homes and communities.