Provider Maintenance Specialist

Position Code: 9915

Department:  Provider Maintenance
Location: Nashville, Tennessee
Immediate Supervisor:  Victor Minicozzi
Status: Non-Exempt
Posted: September 28 2016

Essential Functions of Job:

• Receive and enter provider records into system within accepted quantity and quality guidelines • Access PM reports on the claims systems, Excel & Access • Process PM requests timely to meet time service goals and DOL regulations. • Call Tracks, Suspense Memos, E-mail, PM Ques, Manual Updates • Work closely with PM Staff to assist in training , answer questions for other employees & supervisor/manager, research problems • Research missing information on provider records by contacting providers, and PPO vendors for accurate contract information • Access contract information in the claims system and Cactus • Interact with Provider Relations, Network Access and Claim Units • Request W9s for all new providers added to the claim systems • Enter tax information from W9s in the claim systems. File & maintain W9s • Assist with re-pricing claims • Maintain B-notice files and create Excel spreadsheet for Mail Merge & mailing of B-notice letters • Create & maintain PM Fact Sheets for Client Groups • Manually load per-diem contracts on HAXS for facility providers • Perform special projects as directed by management • Cross train and perform other duties as needed • Adhere to HSB HR policies & procedures • Ability to report to the office

Qualifications:

• High school diploma or equivalent • Effective organizational and prioritization skills • Excellent oral and written communication skills • Basic knowledge of Microsoft Office software applications (Word, Excel, Outlook, Access) • Ability to work in a fast paced multi-tasking environment • Strong interpersonal skills with ability to function as a positive team member • Experience working with Preferred Provider Networks or Healthcare related field a plus

 

The Company considers applicants without regard to race, color, national origin, sex, religion, mental or physical disability, marital status, age 40 years and over, sexual orientation or gender identity, veteran's status, or other characteristic protected by applicable law.

Applications for this vacancy will be received for 3 working days after the Posted date from Employees of HealthSCOPE Benefits with more than one year of service.

Applications for this vacancy will be received for 10 working days after the Posted date from External Applicants.