Coordinador(A) De Administracion De La Red

Coordinador(a) de Administracion de la Red

Regular

Non-Exempt

GENERAL DESCRIPTION:

Responsible for coordinating, routing, and following up on operational requests related to the department and/or unit. Provides administrative support, manages documentation, and ensures compliance with internal processes and regulatory requirements, contributing to operational efficiency and service quality.

ESSENTIAL FUNCTIONS:

•Receives, documents, and routes operational requests related to the network administration from various internal and external channels.

•Monitors and follows up on requests using internal systems and electronic platforms to ensure timely responses, traceability, and compliance with regulatory requirements.

•Manages communications (phone, email, fax, regular mail, or in-person) with providers and internal teams, routing inquiries and reporting potential risks.

•Prepares logs and files administrative documents such as letters of agreement, reports, credentialing files review, provider's exclusion lists, letters to providers, letters to impacted membership, and contracts in compliance with applicable internal and external policies and regulations, as applicable.

•Coordinates meetings, minutes, agendas, and operational activities with providers, external resources, and or internal teams based on business needs.

•Organizes, maintains, or provides physical and digital records to ensure availability for audits, inspections, or internal inquiries upon request.

•Collaborates with other administrative areas and delegated entities to ensure consistency and efficiency in processes supporting the network administration.

•Consolidates and reports operational information to support decision-making, including status updates, operational metrics, and compliance alerts.

•Performs basic validations in internal systems to support the verification of provider status and requirements.

•Participates in special initiatives, audits, and other organizational activities related to the network, following regulatory requirements from local and federal agencies.

•Perform tasks using the appropriate operational software platforms relevant to the unit's functions, such as Customer Relationship Management (CRM), SAI 360, and Credentialing Digital Platform from the Office of Insurance Commissioner, National Practitioner Data Bank, Puerto Rico Medical Licensing Board, and or any other internal or external platform upon request.

• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.

• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: Bachelor's Degree in Secretarial Science, Office Systems, or Business Administration. At least six (6) months of experience performing provider services, network administration, and/or coordination functions, preferably in the Healthcare Insurance Industry.

OR

Education and Experience: Associate's Degree or at least sixty to sixty-four (60-64) approved college credits. At least one (1) year of experience performing provider services, network administration, and/or coordination functions, preferably in the Healthcare Insurance Industry.

OR

Education and Experience: High School Diploma or Technical Course. At least two (2) years of experience performing provider services, network administration, and/or coordination functions, preferably in the Healthcare Insurance Industry.

"Proven experience may be replaced by previously established requirements."

Certifications / Licenses: N/A

Other: N/A

Languages:
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)

"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento"