Network Specialist

Position Code: 9997

Department:  Elect Integration Integrity
Location: Nashville, Tennessee
Immediate Supervisor:  Richard Morrow
Status: Non-Exempt
Posted: July 07 2017

Essential Functions of Job:

• Create and maintain a contract/demographic library and cross reference for all networks. • Interact with Provider Relations, Account Management and EBD Claim Units to develop new networks and research any network discrepancies and/or inquiries. • Access provider data stored on HSB’s network and reformat files as necessary using Microsoft Excel and/or Microsoft Access to format into an appropriate layout. • Work with Tech Services to load provider data from external sources. Tasks include:  Create and maintain load translation table for Cactus extracts of provider data (HSB Network) on the claims processing system.  Prepare load documents (specialty tables, provider type tables, fee & network ID tables)  Download select provider data loads from PPO vendor websites & load on the shared drive for use by PM staff & Tech Services.  Load fee schedules and header records for networks priced online. Maintain fee matrix.  Maintain documentation on all loads.  Verify fee schedule ID’s on incoming data have corresponding fee schedules loaded on the claims systems. If not, requests those fees to be sent from the source to PM management for loading. • Other duties as assigned • Ability to report to the office

Qualifications:

• High school diploma or equivalent • Effective organizational and prioritization skills • Excellent oral and written communication skills • Intermediate/Advance knowledge of Microsoft Office applications (Word, Excel, Outlook, Access) • Ability to work in a fast paced multi-tasking environment • Strong interpersonal skill with ability to function as a positive team member • Ability to quickly grasp new software, experience in computer operations/programming a plus • Logical, analytical approach to understanding of medical, dental, and vision benefits, claims processing, benefit interpretation and PPO network relationships • Knowledge of Healthaxis claims system desired • Minimum 1-3 years of health claims administration experience preferred

 

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.