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« Back to Search Provider Maintenance Specialist
Nashville, TN

Date Posted: September 11, 2017
Job Type: Temporary to Hire
Job ID: 280893

Job Description

Provider Maintenance Specialist

 

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!

 


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