Responsible for the timely and accurate entry of provider demographic, contract affiliation, and fee schedule information into the health plan system.
Must be able to accurately interpret request and configure provider data in such a way that ensures accuracy and claims adjudication is optimized. Essential Functions: Receives information from outside party (ies) for update of information in computer system(s). Analyzes by applying knowledge and experience to ensure appropriate information has been provided.
Maintains department TAT standard for loading of provider demographic data with affiliation and fee schedule attachment. Maintains department quality standard for loading of provider demographic data with affiliation and fee schedule attachment. Works on projects as assigned and within parameters given.
Knowledge/Skills/Abilities: Computer literacy and proficient in Microsoft Excel and Word Excellent organizational skills Ability to interact well with both internal and external customers Excellent verbal and written communication skills Ability to abide by Clients policies Ability to maintain attendance to support required quality and quantity of work Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
High School Degree or equivalent GED Required Experience: 0-2 years Managed Care experience in Claims, provider services, Provider Network Operations, hospital or physician billing, etc.
Must have experience in the following areas to qualify for the position: