Senior Provider Relations Enrollment Representative - Health Plan

Job Title: Senior Provider Relations Enrollment Representative | Health Plan | Sioux Falls

City: Sioux Falls

State: SD

Department *: * Provider & Payor Relations - Sioux Falls

Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr

JOB SUMMARY

The Senior Provider Relations Enrollment Representative is responsible for a variety of duties, including overseeing data entry and training of new enrollment employees for the provider network database. Initiates database improvement efforts and represents the provider enrollment area on IT projects. Develop and produce reports for the Provider Relations Manager and Provider Relations Director. Develop and maintain standards for database integrity. Coordinates maintenance activities for the provider database. Manages communication with other departments regarding database improvements. Responsible for obtaining provider profile information; this includes verifying provider demographic, billing and credentialing information from providers in a timely manner. Entering provider enrollment and disenrollment data and maintaining the provider database. Coordinate with the central verification office and management to resolve operational issues or provider profile discrepancies. Knowledge of credentialing requirements is useful. Responsible for training deliver as well as evaluation and creating training programs. Experience with office equipment preferred. Ability to examine documents for accuracy and completeness. Ability to establish priorities and coordinate work activities. Ability to maintain confidentiality of sensitive information. Ability to communicate clearly and concisely. Ability to work effectively with central verification office, provider office staff and internal health plan staff.

POSITION RESPONSIBILITIES

Demonstrates grasp of new information and its implications. Productively balances speed and accuracy. Trains others on the use of technology in current and planned HR strategies. Chooses among a diverse set of analytical tools according to the nature of the situation. Communicates well downward, upward, and outward. Establishes and maintains effective working relationship with each team member. Demonstrates experience engendering collaborative processes that lead to problem solving and the achievement of business goals, Develop and maintain workplace procedures. Conduct training for non-senior level of this position as well as other positions.

QUALIFICATIONS

High School graduation or GED required. Associate degree or graduate of an accredited Medical Assistant program is preferred.
Previous experience in healthcare industry preferred. Three years prior insurance billing or credentialing experience is preferred.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing.
Every day, we show that commitment by delivering the highest quality of care to the communities we serve.
We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.
In addition to strong clinical care, we are also committed to research, education and community growth.
We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.
We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.
The entire team at Sanford Health recognizes the value of healthy families and communities.
We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
If you are an individual with a disability and would like to request an accommodation for help with your online application,
please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

City: Sioux Falls

State: SD

Job Function: Health Plan

Job Schedule: Full Time

Shift: Days

Req Number: WD03462