Offer summary

Qualifications:

High school diploma or equivalent required; secondary education preferred., Working knowledge of Microsoft Office is essential., Knowledge of Third-Party healthcare operations is advantageous., Strong attention to detail, research, and problem-solving skills are necessary. .

Key responsibilities:

Create and maintain provider records within claims adjudication systems.

Evaluate and resolve customer service inquiries related to provider maintenance.

Support annual IRS procedures and conduct domestic audits.

Collaborate with the Operations Team on provider maintenance projects.

Job description

Position Summary:

The Provider Maintenance Specialist is responsible for maintenance and updates of the data integrity of provider information within the adjudication system and supporting data bases generated from various sources. This position is responsible for ensuring provider records are accurately created and maintained and updates are completed within designated turnaround times.

Position Responsibilities:

Create and maintain all provider records within claims adjudication systems and supporting data bases. This includes setup of demographic and specialty information and evaluation of applicable network association.
Evaluate and complete applicable action associated with data received from multiple networks.
Evaluate and resolve incoming customer service inquiries.
Support analyst referrals related to provider updates driven by real-time claim receipt.
Resolve incoming provider maintenance correspondence according to defined turnaround expectations.
Support annual IRS defined procedures related to the annual evaluation of “B-Notices”, proposed penalty response and support on 1099 filing.
Conduct group domestic audits and documents results/findings.
Maintain provider maintenance manual with documented procedures.
Support various levels of provider maintenance refinement activities.
Collaborates with Operations Team on provider maintenance assignments/projects.
Performs other duties as assigned.

Position Qualifications:

Required

High school diploma or equivalent
Working knowledge of Microsoft Office

Preferred

Secondary education
Knowledge of Third-Party healthcare operations

Skills, Knowledge And Abilities

Exceptional quality and attention to detail.
Strong research skills, follow-up skill, documentation skills and issue resolution skills.
Ability to multi-task.
Ability to think independently with strong problem-solving skills with a service-oriented attitude.
Excellent oral and written communication skills.
Ability to function as a team player and provide assistance to management and other MBS staff as required
Initiative to learn Third Party Administration concepts and philosophies

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.

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