- Maintain provider data integrity across all internal systems and ensure consistency in payer records.
- Audit provider appearances in payer directories and drive corrections to improve search accuracy for members.
- Reconcile provider rosters against payer records on a scheduled basis to proactively identify discrepancies.
- Act as the primary point of contact for enrollment and provider-data escalations.
- Collaborate with the Revenue Cycle team to investigate, triage, and address root causes of claim denials.
- Interpret and research payer policies, including telehealth rules, fee schedules, and prior authorization requirements.
- Develop and maintain internal documentation for payer requirements to improve operational knowledge sharing.
- Support contracting and credentialing by managing applications, deficiency resolution, and tracking for new health plan partnerships.