• Serves as a mentor to staff ensuring department goals are met.• Acts as team resource in the absence of Team Leader• Communicates with providers/facilities and Network Development regarding contracting issues and related to escalated claim pricing issues• Assists in training and development of training materials• Reviews quality audits for accuracy and provides additional training for staff

• Investigate claim pricing variables and match them against reimbursement contracts to confirm provider claims are pricing accurately• Analyze provider/ancillary contracts, fee schedules/rate sheets and profiles to identify and troubleshoot implementation discrepancies • Communicate with providers/facilities and Network Development regarding contracting issues and related claim pricing issues

• Reviewed provider applications to make certain company and NCQA credentialing standards were being met• Ensured all state specific guidelines were followed regarding credentialing timeframes and special handling instructions• Communicated with Managers and other staff to assist others in learning new databases and creating training documents• Responsible for obtaining missing provider application information by means of phone calls, faxes and mail to provider offices• Prescreened provider applications to confirm necessary information was received• Accurate entered provider data in company applications• Reviewed previously entered provider data to assure correct fee schedule and contract information was displayed in company applications