Provider File Data Researcher

Summary: Under the general direction of the Supervisor, this position will be responsible for maintenance and analysis of provider information, for new and existing Health Plan providers across all applicable Provider Databases. The primary focus is researching, responding to, and resolving issues related to provider data to ensure accuracy and consistency of data across all Provider Databases. This position is responsible for all provider database needs including but not limited to accurate and timely updating of the provider information records, that data is regulatory compliant with all state and federal requirements, and is configured to ensure accurate claims processing and provider reimbursement. Accurately links the appropriate reimbursement to all providers for all claims systems.

Essential Responsibilities/Accountabilities
* Researches, responds to, and resolves all issues related to Provider Databases to ensure data is accurate, consistent and configured to guarantee accurate claims processing and provider reimbursement.
* Performs multiple system transactions relative to maintaining the Provider Information Databases including claims and credentialing systems.
* Executes the appropriate provider database transaction to resolve provider related claim suspends.
* Resolves Crosswalk discrepancies by researching provider data attributes to identify correct provider selection.
* Researches and analyzes provider data to ensure it enforces corporate policy as it relates to system maintenance of Provider Network affiliations and reimbursement methodology through use of knowledge of Health Care Products/Programs, Provider Network arrangements, Provider Reimbursement agreements, and Provider Contractual agreements.
* Researches and analyzes provider data to ensure related State and Federal Provider Network Data requirements are captured and entered into all applicable Provider Information Databases.
* Through research identifies and resolves errors/trends, and applies appropriate corrections to the provider file.
* Interfaces with various functional areas including IT, Business Migration, Claims and Customer Service.
* Interacts verbally and in writing with physician office staff, responds to inquiries.
* Uses knowledge of Health Care Products/Programs, Provider Network arrangements, Provider Reimbursement agreements, Provider Contractual agreements to enforce corporate policy as it relates to system maintenance of Provider Network affiliations and reimbursement methodology.
* Ensures that related State and Federal Provider Network Data requirements are captured and entered into all applicable Provider Information Databases.
* Reviews provider requests and determines the required Provider Information Database transactions.

About Aerotek:

Aerotek, headquartered in Hanover, Md., is a leading provider of technical, professional and industrial staffing services. Established in 1983, Aerotek is an operating company of Allegis Group, the largest provider of staffing services in the U.S. Aerotek operates a network of more than 200 non-franchised offices throughout the U.S., Canada and Europe. For more information, visit .

Aerotek is acting as an Employment Agency in relation to this vacancy.