To ensure accurate and timely loading and maintenance of provider file information through appropriate research. This would include, but not be limited to: initial loads based on claim receipts, provider demographics, vendor information, terminations, and researching, analyzing and making appropriate adjustments to the daily departmental reports.
DEPARTMENT: Provider Relations
REPORTS TO: Director of Network Management
Additional Responsibilities: Candidate Education:
- Performs accurate and timely provider research, verification and analysis. Including verification of license status utilizing designated web pages when new providers are added to the system.
- Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
- Resolves provider load issues within established documented processes.
- Ensures the proper supporting documentation exists and is maintained on file for all load processes.
- Loads and maintains provider data.
- Responds to inquiries from provider field staff,
- Resolves critical errors forwarded from the claims department.
- Updates tracking database.
- Responsible for building and maintaining positive business relationships with business partners.
- Assists in special projects.
- Maintains high quality work.
- Meets productivity expectations.
- Works Auto Analyzer Reports.
- Performs other duties as assigned
- Completes assignments thoroughly, accurately and on time.
- Required A High School or GED
- Required 1 year of experience in health insurance
Licenses and Certifications:
- Advanced Demonstrated written communication skills
- Advanced Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated analytical skills
- Intermediate Demonstrated problem solving skills
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Other Knowledge of Claims Processing
- Intermediate Other Basic understanding of provider types and specialties
A license in one of the following is required:
- Preferred Intermediate Other Knowledge of CPT/HCPCS coding
- Preferred Intermediate Other Knowledge of provider billing practices