Location: Idlewild Ave, Tampa, FL 33634
Reports to: Manager, Configuration
To ensure accurate and timely loading of a provider contract, maintenance and termination processes through appropriate research.
- 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: High School Diploma or GED
- Required: 1 year of experience in an analytical role
- Preferred: 1 year of experience in health insurance or managed care
- Preferred: 1 year of experience using SQL
- Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Basic understanding of contract terms and how they are loaded into the system
- General understanding of provider maintenance and termination processes
- Basic knowledge of provider billing practices
- Knowledge of claims processing
- Peradigm (Diamond)
- Cactus systems
- Knowledge of Diamond provider/vendor files