Job description

The ApexHealth Provider Service Representative is responsible for assisting in the managing of the provider network and relationships for ApexHealth. The network must be developed and maintained to meet all network adequacy requirements and be capable of delivering all healthcare services in the ApexHealth contracted service area.

Responsibilities and Duties:

• Coordinate and complete the Provider Service onboarding process of contracting, entry, credentialing, and ongoing education. Including the utilization of system applications and coordination with internal and external resources
• Actively identify providers within the ApexHealth contracted service area for inclusion in the Provider Network utilizing Quest Analytics and other data sources
• Active support of the Credentialing/Recredentialing of all providers within the ApexHealth network, as needed
• Assist the ApexHealth Network Development team in contacting providers, which includes telephonically and electronically educating providers about ApexHealth, and supplying contracting and credentialing information as needed
• Actively support the ApexHealth plan for service area growth and expansion through proactive network development strategies and techniques
• Maintain active relationships with all external resources, including but not limited to Symplr, CAQH, Quest Analytics, and credentialing verification organizations
• Assist in the ongoing servicing of providers to ensure that a positive relationship is maintained between ApexHealth and its providers
• Support the ongoing provider education and evaluation process
• Maintain the provider complaints and grievances process(es) and ensure that concerns are addressed in a timely and thorough manner
• Perform other duties as assigned

Qualifications

Education:

• Bachelor’s Degree (or an equivalent) is preferred but not required

Experience:

• 3+ years of Managed Care industry experience is preferred
• Experience in Managed Care provider service, contracting, or credentialing is preferred

Skills:

• Strong organizational skills
• A “Do-whatever-it-takes” attitude
• Strong problem-solving and process-improvement skills
• A willingness to provide constructive feedback
• Strong interpersonal skills
• A competent knowledge of systems
• Strong written and oral communication skills

Knowledge/Abilities

Knowledge:

• Thorough knowledge of the ApexHealth mission, vision, and operational structure
• Thorough knowledge of the provider software and systems to manage the functions of contracting, credentialing, and ongoing service. Including but not limited to; CAQH, Symplr, Quest Analytics, and core operating systems
• Knowledge of provider contracts, including but not limited to, Primary Care, Specialty Care, Ancillary Care, Hospital, and Organizational Master

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Schedule:

• Monday to Friday

Work Location: Remote

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