Department: Operations - Provider Operations
Reports: Operations Supervisor
Location: 5301 Idlewild Avenue, Tampa FL 33634
To ensure accurate and timely loading of a provider contract, maintenance and termination processes through appropriate research.
Additional Responsibilities:Candidate Education:
- Loads professional contracts into the Diamond System through appropriate research and provider data load activities.
- Performs accurate and timely provider research, verification and analysis.
- 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.
- Loads new providers as a result of the approved Credentialing Committee Lists.
- Coordinates with Membership for member move requests.
- Assists in updating payable procedure codes, price rules and fee schedules.
- 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.
- Required A High School or GED
- Required 1 year of experience in Analytical Role
- Preferred 1 year of experience in health insurance
Licenses and Certifications:Technical Skills:
- Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Intermediate Other Basic understanding of contract terms and how they are loaded into the system
- Intermediate Other General understanding of provider maintenance and termination processes
- Intermediate Other Basic knowledge of provider billing practices
- Intermediate Other Knowledge of claims processing
- Preferred Intermediate Peradigm (Diamond)
- Preferred Intermediate Other Cactus systems
- Preferred Advanced Other Knowledge of Diamond provider/vendor files