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Provider Operations Coordinator, Sr at WellCare

Posted in General Business 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Atlanta, Georgia

Job Description:

REPORTS TO: Sr Director,  Strategic Operations

DEPARTMENT: GA - Operations



the Network Development team to insure accuracy of contracted provider
information. Responds to inquiries from providers and assists with problem resolution
of issues. Performs data analysis to validate information. Performs regular
audits of system information to insure validity against state credentialing
registry (7400) and provider rosters.  Works through the Network Development team to insure inquiries are
handled timely and appropriately (Does not communicate directly with provider)

 Essential Functions:

  • Works with Network Development team to process new provider load requests along with any new, updates or changes and terms within the group within the regulatory SLA requirement.

    Manages inquires via Salesforce to insure timely processing of requests.

    Addresses inquiries from providers and assists with problem resolution of issues.

    Performs root cause analysis of delays in provider loading and assists in bringing to resolution.  Communicates barriers to leadership in a timely manner.

    Reviews and processes incoming and outgoing paperwork, including directory updates, provider credentialing applications, Contract Maintenance forms and other related forms.

    Tracks new contracts using automated tools.

    Performs quarterly IPA Audits of Xcelys to insure accuracy, against State CVO registry (7400) and provider roster.

    Provides provider data analysis support as needed.

    Special projects as assigned or directed.




Education:  Associate's degree preferred
Experience:  3+ years experience in provider loading, provider relations or claims with exposure to problem resolution
Special Skills (e.g. 2nd language):  Excellent problem solving skills.  Excellent oral and written communication skills.  Must be organized and have excellent time management capabilities.  Ability to analyze data to identify trends, and variance from goals.