Provider Services Coordinator

Health Plan of San Mateo•South San Francisco, CA

About The Position

This role will be responsible for processing provider Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) requests and coordinating HPSM Provider Directory Updates with a special focus on data intake, data entry, and data validation. The Provider Services Coordinator will validate sensitive financial information, identify potential risk factors, and ensure accuracy and compliance in provider financial data

Requirements

Associate’s degree or equivalent combination of education, training, and experience required.
Minimum of two years of experience in healthcare or financial data processing preferred.
Intermediate proficiency in Microsoft Office Suite applications.
Intermediate data analysis and reconciliation skills.
Advanced data entry and maintenance skills with high attention to accuracy.
Advanced written and verbal communication skills.
Basic knowledge of provider payment processing preferred.
Basic knowledge of provider directories or provider network data preferred.
Working knowledge of principles related to data security, integrity, and validation.
Demonstrated ability to maintain accuracy and effectively prioritize tasks.
Demonstrated ability to analyze and reconcile data discrepancies.
Ability to exercise discretion when handling sensitive financial and provider data.
Ability to process and update provider data changes accurately and in a timely manner.
Ability to build and maintain collaborative relationships across departments and with providers.

Nice To Haves

Minimum of two years of experience in healthcare or financial data processing preferred.
Basic knowledge of provider payment processing preferred.
Basic knowledge of provider directories or provider network data preferred.

Responsibilities

Provider Director Maintenance
Receive, review, and process provider demographic change requests.
Perform outreach to provider offices to verify information accuracy and completeness, ensuring timely updates in the system of record.
Respond to provider calls and inquiries regarding a variety of needs in a timely manner.
Work closely with internal teams to ensure provider data is reflected accurately.
EFT/ERA Processing &Validations
Facilitate the intake and verification of EFT/ERA requests from providers.
Validate banking and remittance information for providers.
Act as the main contact for resolving EFT/ERA issues and guiding providers.
Training & Process Improvement
Deliver hands-on support to providers navigating HPSM’s provider portal, including assistance with EFT/ERA submissions and demographic updates.
Escalate complex issues and maintain a high level of customer service and professionalism.
Identify recurring issues or inefficiencies in workflows and recommend improvements.
Support provider data integrity initiatives and automation improvements.
Maintain up-to-date documentation of procedures, templates, and FAQs.
Adhere to work performance norms and attendance expectations.
Perform other duties as assigned.