Senior Provider Operations Specialist - Remote

Summary of Job

Manage the relationship between Cognizant and Provider Network Management. Outreach to providers as needed when discrepancies in Provider Data or required documentation is needed for compliance requirements. Maintain current knowledge of NCQA, state and federal requirements. Maintain communications with provider offices to promote relationships imperative to process. Serve as a subject matter expert and support Provider Ops Specialists. Collaborate cross-functionally to streamline workflows, support audits, and drive process improvement.

Responsibilities

• Partner with the Credentialing Supervisor to monitor daily reports and dashboards.
  
• Collaborate with leadership to identify areas of improvement and root cause analysis based on internal and external audits.
  
• Responsible for the development and review of training materials, desktop procedures and policies. Provide feedback on cross-departmental projects and initiatives.
  
• Accountable to outreach recredentialing non-responders to ensure compliance with recredentialing standards and prevent provider termination.
  
• Establish and maintain subject matter expertise on Federal, State, and NCQA regulatory and compliance requirements and assist in driving policy and process at an enterprise level (EH, CCI, NJ).
  
• Take initiative to continuously develop and conceptualize approaches on more efficient ways to perform recredentialing outreach and maintain accurate provider data.
  
• Work as a liaison between Cognizant Credentialing team and Provider Network Management to address any process issues or provider education needs.
  
• Analyze recredentialing report data to compare intended outcomes with actual outcomes and evaluate quality controls to assess effectiveness in identifying errors in the process.
  
• Proactively identify opportunities for improvement, systematic enhancements, and standardization of departmental practices across the enterprise of Credentialing and Recredentialing.
  
• Communicate results to Manager and Provider Operations Tower Leaders.
  
• Assist Provider File Operations when data discrepancies are found to outreach providers as necessary and ensure accurate provider directories.
  
• Perform all other related duties as directed or required.