Provider & Network Coordinator
Company: Beacon Health Options
Posted on: September 17, 2020
Beacon Health OptionsJob Category: Provider & Network -
Relationship MgtReq #: NETWO02882Schedule: Full TimeLocation: MI -
WixomWe Help People Live their Lives to the Fullest Potential!
For more than 30 years, Beacon has changed the way people live with
behavioral health conditions. Today, we are the undisputed leader
in behavioral health management, serving 40 million people across
all 50 states. At Beacon, we are committed to delivering a
'world-class' candidate experience from the moment you click
'Apply'! Our goal is to help you reach your fullest potential,
while utilizing your talents and expertise to help us deliver on
Do you have a passion for helping others? If so, we are looking for
Beacon is currently seeking a Provider & Network Coordinator to
join our team in Wixom, MI. Responsible for various levels of
activities supporting the recruitment, credentialing and
contracting process for potential and current Beacon providers.
Responsibilities may range from maintenance support, provider
education and communication with internal customers and Beacon
providers, to reviewing provider files/programs and monitoring
program compliance with applicable standards and regulations.
Responsible for phone coverage. Provides internal support and
follow-through in completion of the Provider Relations functions.
Supports the local provider relations staff, including provider
relations managers by providing research, problem resolution,
administrative support and follow-up on a variety of provider
issues that may arise. Coordinates activities with other internal
Beacon departments to provide optimal customer service to network
providers and internal customers. Special projects and other duties
What does a typical day look like?
- Answers practitioners'/facility recruitment questions regarding
Beacon policies and procedures, contracting requirements, and
claims issues. Participate in responding to provider inquiries and
- Provides follow up with practitioners and facilities for the
return of completed credentialing and re-credentialing applications
and contract documents. Verifies claims and application information
with providers to update database. Process letters of resignation
and may initiate disenrollment's. Responds to provider requests for
- Provides assistance in compilation and mailing of provider
recruitment mailings, general information and educational materials
to network practitioners as required. Assists Provider Relations
Managers with research to identify new providers for recruitment
into the Beacon provider network. Initiates written requests to
providers for credentialing information. Responsible for the
coordination and implementation of activities necessary for the
identification, review and selection of mental health and substance
abuse treatment providers in support of Beacon Network Development.
Performs research and problem resolution on issues related to
provider complaints, claims reported to have been processed
incorrectly, coordinating credentialing paperwork, provider
communications or verification of information as requested. Assists
Provider Relations Managers with report requests for network
management purposes. Reviews/analyzes provider information through
database queries. Review denial reports, weekly approval
disenrollment grids and research information regarding this
provider and the area(s) served. Meet with Provider Relations
Managers and Director, Provider Relations staff and Service Center
staff to present information discuss plans of action to avoid
disenrollment of key providers. Researches files and databases to
address provider questions. Analyze beneficiary and provider
demographics and generate proposed network configuration for review
and incorporation into formal master plans produces by the Network
Development Unit. Participate in the analysis and monitoring of
provider utilization and performance data to ensure appropriate
utilization for network providers and identify needs for network
modifications as well as for initial and ongoing network
configurations. Resolve customer/member/provider claims issues
through investigation and problem solving. Follow-up on inquiries
as needed, referring problems to other appropriate Beacon personnel
as identified. Reviews/analyzes providers' status through database
queries. Researches files and databases to address provider
questions. Prepares and disseminates reports.
- Obtain, process, manage and maintain both hard-copy and
computer based provider information necessary for network
development and maintenance activities. Participates in the
maintenance for files within a national database of potential and
existing network providers. Attend all staff meetings, team
conferences and in-service as directed. Maintain daily logs for
future reference and analysis as well as document inquiries and
complaints appropriately in MHS, Phoenix and Prism. Enter data
accurately and timely into systems. Perform routine clerical
functions including filing, copying, faxing, typing and record
- Works closely with regional Network Operations team to ensure
seamless customer service to providers. Interface with MSR, Care
Managers and Claims staff to give information about provider
contract/credentialing status to facilitate claims payment and
referrals. Interface with external and internal customers to ensure
optimal efficiency of service. Address concerns of dissatisfied
and/or angry customers/members/providers in a diplomatic manner.
Respond to customer inquiries professionally and efficiently.
Assist in day to day departmental activities including phone
coverage and file maintenance.
- Apply Beacon policies and procedures consistently. Maintain
confidentiality of Clients, Business Records and Reports. Maintain
ethical and professional standards. Maintain individual
productivity and performance standards. Meet Departmental
expectations, accuracy, productivity and performance standards.
Support Beacon in achieving Mission Statement. Adhere to the
components of the Compliance Program. Ensure that job tasks are
performed in a legal and ethical manner. Actively assess work area
for non-compliance issues and notify supervisor or call Ethics
Hotline. Adhere to compliance training requirements and understand
that training is required condition of employment. Complete tasks
accurately and within required time frames.
What you Contribute?
Education: This position requires a Bachelors' Degree in a Human
Services field, equivalent Bachelor's Degree or equivalent work
experience in a behavioral health or managed care environment in
lieu of a Bachelor's degree.
Knowledge, Skills & Abilities: At least three years of experience
in customer service, claims, auditing or provider relations in the
behavioral health or managed care setting is required. Knowledge of
and experience in provider benefits administration/health care
setting. Knowledge of and experience with providers and provider
network. Excellent verbal and written communication skills. Have a
professional bearing and be able to speak comfortably with
physicians, senior facility administrator and mental health
professionals. Have strong problem-solving skills. Position
requires some travel.
What Makes Us Different?
- Here, it's not just a job - it's an opportunity to change
- Our employees are learners, innovators and original
- Our mission and values guide the way we treat our members,
providers and each other.
What We Have to Offer:
- Healthcare benefits available starting day 1!
- Health & wellbeing incentives, such as gym membership
- 401K with company match to help reach your future financial
- Generous PTO, because we know life happens outside of work
If Beacon sounds like the place for you, what are you waiting for?
Apply with us today to get started!
Click below on "Apply for this Position" to create a profile and
apply for the position
Beacon Health Options company, is proud to be an Equal Opportunity
and Affirmative Action Employer as well as a Drug Free and Tobacco
Free Work Environment. EOE/AA/M/F/Veterans/Disabled
At Beacon Health Options, our candidate's data privacy is a top
priority. Our recruiting team conducts all communications using
official company email (@BeaconHealthOptions.com). Only candidates
who have applied for an open position through our Careers page
(careers.beaconhealthoptions.com) will be engaged in our interview
process. Beacon conducts all interviews in person or over the
phone. At no time during the recruiting process will any Beacon
recruiter request any financial or personally identifiable
information from you.
Keywords: Beacon Health Options, Detroit , Provider & Network Coordinator, Other , Wixom, Michigan
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