Specialist, Provider Network Administration

Job description

JOB DESCRIPTION: Job Summary: Provides support for provider network administration activities. Responsible for accurate and timely validation and maintenance of critical provider information on all claims and provider databases, and ensures adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts. Essential Job Duties: - Receives information from outside parties for update of provider-related information in applicable computer system(s). - Reviews/analyzes data by applying job knowledge to ensure appropriate information has been provided. - Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment. - Ensures accurate entries of information into health plan systems. - Audits loaded provider records for quality and financial accuracy, and provides documented feedback. - Assists in resolution of configuration issues with applicable teams. - Provides support for provider network administration projects. Required Qualifications: - At least 3 years of health care experience, to include experience in claims, provider services, provider ne...