Provider Review Services Coordinator

Job Summary

The Provider Review Services Coordinator supports provider review operations through project coordination, data preparation and transformation, reporting, documentation, and systems support. The position coordinates both defined and ongoing specialty projects while helping ensure that review teams and clients have accurate information, appropriate access, and timely operational support.

Role Impact

This role improves the accuracy, efficiency, and continuity of provider review services by reducing project delays, maintaining organized workflows, and supporting timely communication, data integrity, reporting, and issue resolution.

Essential Job Functions

• Coordinates provider review projects, including ongoing specialty work, review-preparation activities, kickoff and provider calls, staff scheduling, project setup, contact lists, secure-portal permissions, and status tracking.
• Creates and maintains project resources in Particle, Nucleus, Microsoft Teams, OneNote, SharePoint, and related systems; monitors remote access and works with Information Technology to resolve outstanding needs.
• Reviews, validates, formats, and transforms project data; runs pivot tables; selects samples based on client criteria; and imports pull lists, chart samples, rebuttals, and related information into the audit database.
• Identifies and retrieves missing documentation, supports chart replacements, and organizes records needed for provider reviews, quality-assurance activities, project completion, and closeout.
• Runs, validates, uploads, and distributes standard and customized reports and maintains accurate project records and status updates.
• Reviews project-related invoices and supporting documentation for accuracy, communicates discrepancies, and assists with additional provider review initiatives and special projects.

Required Skills and Experience

• Experience with ETL data transformation and tools such as OpenRefine, ASAP Utilities, Microsoft SQL, or comparable applications.
• Advanced Microsoft Excel skills, including formulas, pivot tables, and data analysis, with proficiency in Teams, OneNote, SharePoint, and related business systems.
• Strong working knowledge of ICD-10-CM, and CPT coding, with a solid understanding of health informatics.
• Project-management and organizational skills, including the ability to coordinate ongoing work, manage competing priorities, maintain accurate documentation, and meet deadlines.
• Experience reviewing reports, invoices, data, and supporting documentation for completeness and accuracy.
• Strong written, verbal, interpersonal, problem-solving, and independent-work skills, with appropriate discretion when handling confidential information.

Preferred Qualifications

• Experience in information technology within the Health Information Management industry.
• Experience supporting provider review, audit, coding, clinical documentation, or related Health Information Management workflows.

Performance Expectations

• Maintains confidentiality and complies with HIPAA, company policies, and applicable requirements.
• Demonstrates professionalism, sound judgment, accountability, responsiveness, and follow-through.
• Works independently and collaboratively, adapts to changing priorities and systems, and takes a solutions-focused approach to improving workflows.
• Maintains current job knowledge and completes reports, timesheets, expenses, personnel updates, and other required documentation accurately and on time.