JOB SUMMARY:

Frontline of Network Development, responsible for providing excellent customer service while impacting and overseeing provider data integrity. This individual must combine strong interpersonal skills with an aptitude in the medical provider market.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Assist Developer with implementing medical providers through use of correspondence and telephonic contact.
• Verify all provider signatures, contracts and documentation before submitting for internal processing.
• Review credentials of prospective providers to be considered for acceptance into network per national credentialing requirements and protocols.
• Provide orientation on managed care procedures and establish liaison(s) with all participating providers.
• Assist and communicate a provider orientation program in cooperation with Developer.
• Distribute and maintain provider manual and orientation materials per state guidelines.
• Receive and resolve all disputes involving provider contract and payment issues in accordance with contract Dispute Resolution Procedures.
• Provide assistance and be responsive to staff requests for assistance, information regarding the network, both locally and nationally.
• Oversee distribution of executed contracts and maintenance of database.
• Assist with network marketing, employer and payor relations and product development.
• Conduct and manage provider data audits that ensure data integrity for network and oversee all provider updates and changes with NDB.
• Coordinate and process provider roster updates at least annually or as otherwise required.
• Perform facility site surveys as needed per credentialing requirements or state guidelines.
• Identify anemic specialties within network and generate a recruitment list for Developer.
• Requires regular and consistent attendance.
• Maintain a professional appearance.
• Additional duties as assigned.

KNOWLEDGE & SKILLS:

• Strong interpersonal skills and adaptive communication style, complex problem solving skills, drive for results, innovative
• Ability to continually adapt daily routines that allow each function to be manageable.
• Ability to properly prioritize and manage assignments, scheduled or unscheduled
• Ability to embrace new tools and procedures per corporate guidelines and objectives.
• Strong organizational skills

• Excellent written and verbal communication skills
• Superb attention to detail and ability to deliver results in a fast paced and dynamic environment.

EDUCATION/EXPERIENCE:

• Associate’s degree or two or more years equivalent work experience
• Proficient in Microsoft applications
• Customer service education/training within the insurance industry, managed care or related field

Application Instructions:

In order to provide equal employment and advancement opportunities to all individuals, employment decisions at CorVel will be based on merit, qualifications and abilities. Except where required or permitted by law, employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex, national origin, ancestry, citizenship, age, handicap or disability, marital status, medical condition or any other characteristic protected by applicable law. Please be aware that CorVel generally does not review all applications submitted in response to job openings posted on the Internet because of the large volume of responses. Note to Employment Agencies: Please do not forward agency resumes. CorVel Corporation is not responsible for any fees related to unsolicited resumes.