We are seeking a dedicated and experienced Nurseto join our dynamic team.
The ideal candidate will have a strong background in provider network management and will collaborate closely with our Claims Department and Call Center teams to ensure seamless healthcare service delivery and provider coordination.
Key Responsibilities
Manage and maintain relationships with healthcare providers in the network.
Monitor provider performance and ensure compliance with healthcare standards and regulatory requirements.
Work closely with the Claims Department to review and validate medical claims.
Support the Call Center team in resolving provider-related inquiries and complaints.
Ensure adherence to healthcare regulations and internal policy guidelines.
Participate in the onboarding and credentialing of new providers.
Requirements
Interested candidates should possess a Bachelor's Degree with 2-5 years experience.
Strong knowledge of healthcare regulations, policies, and clinical best practices.
Excellent communication and interpersonal skills.
Strong analytical and problem-solving abilities.
Ability to work collaboratively across departments.