Perform day to day duties of assuring that providers are set up accurately in the provider information system for state reporting, claims payment, and directories.
Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up.
Provide support to the external provider representative to resolve provider data issues.
Research and effectively respond to provider related issues.
Submit provider data entries to resolve provider-related demographic information changes.
Initiate and process provider add, change and termination forms.
Create and maintain spreadsheets used to produce provider directories for multiple products.
Track, update and audit provider data.
Identify adds, deletes and updates to key provider groups and model contract.
Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment.
Provide assistance to providers with website registration.
Facilitate provider education via webinar.
Work with other departments on cross functional tasks and projects.
Facilitate new provider orientations.
Facilitate provider trainings.
Performs other duties as assigned.
Complies with all policies and standards.

Associate's degree and claims processing, billing and/or coding experience preferred.
Three years of experience in managed care environment, medical provider office, customer service within a healthcare organization, and medical claims.
Knowledge of health care, managed care, Medicare or Medicaid.

Provider Engagement Network Specialist

About this role