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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.
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
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
Licenses and Certifications: 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