• Corporate Provider Services Representative

    Job Location US-MI-Detroit
    Job ID
    Provider & Data Analytics
    Business Line
    CMC Corporate
  • Overview

    Who we are:

    Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.


    We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio.  As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.


    Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.


    A Day in the Life of a Corporate Provider Services Representative: 


    This position provides provider servicing and contracting subject matter expertise. This position works closely with the, Credentialing, Claims, Finance, Provider Data Analytics and Provider Network Development Representative to assure timely and accurate entry and resolution of provider demographic, contract affiliation, and fee schedule information into the health plan system. Responsible for researching provider claims issues, provider contracts, fee schedules to determine root cause of payment error.


    • Reviews all applications, provider requests and supporting documentation for accuracy and completeness and adds the information to the file according to policy, in a prompt, timely manner as directed per contractual guidelines
    • Maintain knowledge of the credentialing requirements of all national, CMS and State agencies, including National Committee for Quality Assurance (NCQA), URAC, or general accreditation and support the Credentialing Manager in fulfilling credentialing department expectations
    • Responsible for answering the Provider Services phone queue
    • Occasional special projects related to provider services
    • Prospecting and responding to potential providers for inclusion in the MHP Provider Network
    • Collecting and data entry all practitioner and ancillary signed contracts, applications and necessary credentialing information ensuring MHP’s credentialing standards is maintained
    • Provide exceptional customer service to Provider Network for all States while receiving or making provider calls
    • Complete necessary forms when needed to update Provider changes and or additions in MCS (complete and submit appropriate documentation for proper set up in MCS)
    • Enters new provider data, provider demographic and contract affiliation information into the Managed Care System
    • Process information for updates to information and analyze by applying knowledge and experience to ensure appropriate information has been provided
    • Assist with network expansion by working closely with the Business Development Team


    What you can bring to Meridian:

    • High school diploma is required
    • Pursuit of a Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is preferred
    • At least one years of managed care or provider services experience is preferred
    • Basic knowledge of MHP’s philosophy, organizational structure and plan overview
    • Thorough knowledge of MHP’s credentialing standards and contracting requirements
    • Knowledge of National Committee for Quality Assurance (NCQA), URAC or general accreditation requirements and how they directly relate to the function of the position
    • Basic knowledge of the managed care industry
    • Organizational and team skills
    • Follow up skills, with a “do whatever it takes” attitude
    • Proficiency in scanning and attachment of electronic files
    • Efficient computer and data entry skills, including knowledge of software products: MCS, MS Word and Excel
    • Ability to communicate clearly and concisely both orally and in writing
    • Ability to work as part of a team while maintaining and exceeding individual goals and objectives
    • Professional and pleasant demeanor

    What Meridian can offer you:

    • Our healthcare benefits include a variety of PPO plans that are effective on the first day of employment for our new full-time team members.
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • Meridian offers 401k matching that is above the national average.
    • Full-time MHP employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
    • Meridian Health Plan was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian. 

                                                                   Equal Opportunity Employer


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