Provider Information Management Specialist in Meridian, ID at Volt

Date Posted: 10/1/2019

Job Snapshot

Job Description

POSITION PURPOSE:

To accurately input and maintain provider information contained in the provider database. Work with Provider Services staff and providers to assure accurate data is acquired and maintained for prompt and accurate claim processing. Assist Benefits Administration personnel with claim issues related to providers. Ensure new providers are loaded to existing contracts within a timely manner.

MINIMUM POSITION REQUIREMENTS:

 Required Experience:

  • One year in an insurance or healthcare setting.
  • Experience with medical or dental claims

  Required Knowledge, Skills, and Abilities (KSAs):

        Knowledge of:

  • Medical provider office billing practices or claim processing
  • Provider demographic information and billing practices

        Skills:

  • Microsoft Word – Basic
  • Microsoft Excel - Basic
  • Organizational
  • Verbal and written communication
  • Ten Key 75 kspm

        Ability to:

  • Work with detail-oriented material
  • Adapt to multiple claim types and guidelines required
  • Work in a team environment
  • Work overtime as needed

PREFERRED QUALIFICATIONS:

  • Knowledge of networking programs and the provider systems
  • Medical Terminology
  • Medical billing experience
  • Claims filing procedures

PRIMARY ACCOUNTABILITIES: 

  1. Research or set up provider number and assign provider numbers to claims that fail to match a provider in Facets.
  2. Research and respond to Benefits Administration personnel questions regarding provider data on claims.
  3. Interpret and enter all required provider information accurately and timely.
  4. Verify appropriate data including licensure, National Provider Identifier (NPI), Tax identification number (TIN), and dental GRID.
  5. Maintain a positive working relationship with the provider community through verbal and written communication.
  6. Identify and enter appropriate networking to providers using Provider Type and Agreement matrixes.
  7. Create and maintain information on non-payable provider numbers to be used by Medical Management for referral and pre-authorization purposes.
  8. Ensure new providers are loaded to existing contracts in a timely manner.
  9. Enter on-call providers into the provider file in Facets.
  10. Stay current on all information related to claims processing such as Claims Administration Team Memos (CATS), Benefits Administration Guidelines (BAGS) etc.

SECONDARY ACCOUNTABILITIES:

  1. Send all documentation for imaging to ensure documentation is properly retained. Note the Document Control Number (DCN) in the provider file correctly.
  2. Operate business office equipment such as PC, ten-key, phone, and copy machine.
  3. Perform other duties as requested by the Supervisor.

Volt is an Equal Opportunity Employer