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Provider Database Coordinator

2 months ago

Irvine, United States Johnson Service Group Full time
Job DescriptionJob Description

 

Johnson Service Group (JSG) is seeking Healthcare Provider Database Coordinators with claims processing experience.
Days/hours:  Monday-Friday- 8:00am-5:00pm
Hourly wage: $20.00-$22.00 per hour
This position is fully remote

QUALIFICATIONS
• High school education or equivalent and two (2) plus years of healthcare coding/billing and/or provider credentialing/eligibility experience.
• Excellent data entry skills with outstanding manual dexterity.
• Strong phone and verbal communication skills.
• Proficient in Microsoft Office (Word, Excel, Outlook).
• Basic ability to navigate basic computer systems and website applications.
• Healthcare knowledge as it relates to provider billing practices for medical and dental.
• Knowledge of medical terminology, claim fields, and the basics of HMO, PPO, EPO, POS, Self-Funded, Large plan products, and State/Federal payers Medicare & Medicaid.
• Basic knowledge of Medicare Fee Schedule and the design, CPT/HCPS service coding, understanding the provider types and their impact on claims and reimbursements.
• Basic understanding of participating and non-participating policies and contracting information.
• Experience in Provider credentialing & enrollment– National Provider Identifier (NPI) database and what information is provided.

DUTIES AND RESPONSIBILITIES
Data Entry and Database Maintenance
• Load accurate provider information into HCPS as indicated on the medical/dental claim form.
• Review and research provider medical and dental claims for complete and accurate information, including address, phone number, license number and Federal Tax ID numbers.
• Maintain the non-Anthem eligible plans on all Anthem providers.
• Load Preferred Provider Organization (PPO) network from all third-party vendors as applicable to the appropriate health benefit plan.
• Utilize pricing guidelines, support the claim pricing processes and apply based on participating or non-participating providers.
• Create provider files utilizing knowledge of provider types, and department/regulatory codes for proper use of the maintenance files.
• Maintain interactions with various provider network system for contracting and claim support.
• Assist in the review and maintenance of the Anthem weekly provider updates utilizing reports available.
• Assist in the maintenance and resolution of Internal Revenue Service (IRS) requests, IRS 1099 form issues and levies. Assists in the review of the IRS 1099 form edit report at year-end for discrepancies.
• Maintain W-9 forms on file for all providers.
Customer Service
• Manage all provider maintenance requests and forward completed work back to appropriate department.
• Research Anthem and any other third-party PPO network to resolve any provider contract issues involving participating and non-participating status as well as any pricing area issues.
Other
• Maintain a Health Insurance Portability and Accountability (HIPAA) compliant workstation and utilize appropriate security techniques to ensure HIPAA required protection of all confidential/protected client and enrollee data.
• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.
• All other duties as assigned.

Company DescriptionOur people and culture make JSG a great place to work. We are all about growing and investing in our staff. JSG’s mission is to empower people, help our clients reach their goals, and hire motivated individuals.

We offer medical, dental, vision, life insurance options, paid time off, sick time, 401(k), weekly pay, and more.

Johnson Service Group, Inc. (JSG) is a North American leader in the staffing and consulting services industry, with 40 years of experience investing in people and companies. We are always looking for great people to join our team—we want to see your success here at JSG

We can be found locally in more than 30 offices throughout the United States and Canada. JSG continues to work diligently to offer our clients and candidates world-class service and diversified offerings to fit their evolving needs.

Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.Company DescriptionOur people and culture make JSG a great place to work. We are all about growing and investing in our staff. JSG’s mission is to empower people, help our clients reach their goals, and hire motivated individuals.\r
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We offer medical, dental, vision, life insurance options, paid time off, sick time, 401(k), weekly pay, and more.\r
\r
Johnson Service Group, Inc. (JSG) is a North American leader in the staffing and consulting services industry, with 40 years of experience investing in people and companies. We are always looking for great people to join our team—we want to see your success here at JSG\r
\r
We can be found locally in more than 30 offices throughout the United States and Canada. JSG continues to work diligently to offer our clients and candidates world-class service and diversified offerings to fit their evolving needs.\r
\r
Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.