Provider Maintenance Specialist

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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