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Provider Maintenance Specialist Jobs

Company

MedCost LLC

Address , Remote
Employment type
Salary
Expires 2023-07-11
Posted at 1 year ago
Job Description
Provider Maintenance Specialist
Position Summary:
The Provider Maintenance Specialist is responsible for maintenance and updates of the data integrity of provider information within the adjudication system and supporting data bases generated from various sources. This position is responsible for ensuring provider records are accurately created and maintained and updates are completed within designated turnaround times.
Position Responsibilities:
  • Conduct group domestic audits and documents results/findings.
  • Evaluate and resolve incoming customer service inquiries.
  • Support various levels of provider maintenance refinement activities.
  • Resolve incoming provider maintenance correspondence according to defined turnaround expectations.
  • Support analyst referrals related to provider updates driven by real-time claim receipt.
  • Performs other duties as assigned.
  • Evaluate and complete applicable action associated with data received from multiple networks.
  • Collaborates with Operations Team on provider maintenance assignments/projects.
  • Create and maintain all provider records within claims adjudication systems and supporting data bases. This includes setup of demographic and specialty information and evaluation of applicable network association.
  • Support annual IRS defined procedures related to the annual evaluation of “B-Notices”, proposed penalty response and support on 1099 filing.
  • Maintain provider maintenance manual with documented procedures.
Position Qualifications:
Required
  • High school diploma or equivalent
  • Working knowledge of Microsoft Office
Preferred
  • Knowledge of Third Party healthcare operations
  • Secondary education
Skills, Knowledge and Abilities
  • Ability to multi-task.
  • Strong research skills, follow-up skill, documentation skills and issue resolution skills.
  • Exceptional quality and attention to detail.
  • Ability to think independently with strong problem-solving skills with a service oriented attitude.
  • Initiative to learn Third Party Administration concepts and philosophies
  • Ability to function as a team player and provide assistance to management and other MBS staff as required
  • Excellent oral and written communication skills.

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.