Provider Network Specialist

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Provider Network Specialist

Middletown, CT, US

The Provider Network Specialist provides support to complete activities associated with credentialing of providers and collection of quality of service information for the Department of Children and Families (DCF) fee for service provider network and other provider networks as assigned. In addition, this position provides and coordinates administrative and provider relations support services. Duties may include application processing, maintenance of credentialed provider rosters, collection of quality of service information, and provider support service.

This position will represent ABH® and its services in a positive and professional manner and adhere to ABH®’s best practices, guidelines, policies and procedures as established, promoting ABH® as a leader in behavioral healthcare in all interactions and work.

DUTIES AND RESPONSIBILITIES:

• Process new provider applications and process provider reapplications as necessary, ensuring that paperwork is complete, accurate and in compliance with DCF (and other agency) standards and ABH® process guidelines including; but not limited to, preparation of the credentialing documents and ongoing maintenance of the documents, primary source verification, documenting credentialing and provider information in the data system;
• Provide excellent service to providers in a professional and respectful manner to include fielding phone calls, initiating and returning written correspondence, and updating materials as needed and requested;
• Assist in maintenance of an updated list of credentialed providers for use by the DCF Area Office staff in offices throughout CT;
• Assists in providing technical assistance to providers and provider staff to include orientation, site visits and education of Department policies and procedures as determined by the Director, Credentialing & Fiduciary Services;
• Proactively identifies to the Director, Credentialing and Fiduciary Services, opportunities to improve provider understanding;
• Proactively makes Director, Credentialing and Fiduciary Services aware of any downtime so that other projects can be maintained;
• Collect and maintain quality of service information on specific providers and consult with Director of Credentialing & Fiduciary Services regarding QOS issues;
• Provide ongoing provider relations and customer service regarding credentialing procedures and application status;
• Maintains confidentiality of all client protected health information and adheres to all HIPAA related policies and procedures;
• Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds;
• Performs other tasks/responsibilities as required to support the business operation

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Five years demonstrated work experience in credentialing, customer service and administrative functions;
• Attend annual Conflict of Interest training.

KNOWLEDGE/SKILLS/ABILITIES:

• Excellent organizational skills with a strong attention to detail;
• Flexibility and ability to manage multiple tasks;
• Ability to interact with various internal and external stakeholders (client, state agencies, providers, etc.);
• Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel, Power Point, Access, Outlook); internet;
• Strong written and verbal communication skills required.