PNA Administration Representative

Job Description

Job Title: PNA Administration Representative

Department: Provider Administration

Location: Austin, Texas

Reports To: Director, Provider Administration

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Position Summary

The PNA Administration Representative is responsible for processing and credentialing incoming direct provider agreements and maintaining accurate network updates for the IPA division. This position plays a key role in ensuring compliance with credentialing standards, managing provider data, and supporting departmental operations. The representative will also contribute to cross-functional projects and support communication with internal and external stakeholders.

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Essential Duties and Responsibilities

• Credential direct provider agreements in accordance with organizational guidelines and within established turnaround times.
• Conduct Primary Source Verifications, including but not limited to, state license validations and hospital privileges checks; additional verifications may apply depending on state requirements.
• Perform queries in the National Practitioner Data Bank (NPDB) and flag providers requiring Medical Review Committee evaluation.
• Conduct quality control audits on pended and non-pended claims.
• Respond to provider and facility inquiries regarding contracts or credentialing issues through both written and verbal communication.
• Support the Provider Administration Department’s Queue Line by addressing contracting-related questions from providers or facilities.
• Accurately process updates for directly contracted providers and IPA networks using Microsoft Word, Excel, and other approved formats.
• Coordinate with IPA network contacts via phone, email, or fax to clarify and resolve update-related inquiries.
• Log and archive all incoming direct and IPA updates using Microsoft Outlook and designated storage protocols.
• Manage and prioritize multiple departmental projects concurrently while ensuring deadlines are met.
• Handle time-sensitive assignments as directed by management.
• Crosstrain on other departmental functions to ensure operational flexibility and support.
• Maintain accurate and timely daily production reports.
• Provide backup coverage for Customer Care calls using the SO2 Call Tracking System, as needed.
• Comply with the organization’s Information Security Policies and Procedures.
• Ensure strict adherence to HIPAA guidelines and privacy standards.

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Additional Expectations

• Demonstrate professionalism, attention to detail, and the ability to manage sensitive information with confidentiality.
• Foster collaborative relationships across departments and with external partners.
• Exhibit adaptability in a dynamic work environment and be willing to perform duties outside of the core job description as assigned by management.