Configuration Provider Specialist

2 weeks ago

Temple, United States CornerStone Technology Talent Services Full time

CornerStone Technology Talent Services is seeking a Configuration Provider Specialist within a reasonable driving distance near Temple, TX.

Summary:
Responsible for entering and maintaining provider demographic and contractual data within the claims processing system and working with various departments to answer questions regarding information configured within the provider database.
Essential Functions:
• Maintains provider database, utilizing credentialing data, the NPPES and other data sources to ensure data integrity within the claims processing system.
• Works in conjunction with Network Development to enter new contracts into the system and make modification to existing contracts.
• Collects IRS W-9 forms from providers to validate/update configured information.
• Collaborates with enrollment operations to effectively coordinate member re-assignment upon termination of a PCP. Assists in the selection of the appropriate pricing template to apply to contracts.
• Works in conjunction with the Compliance Department to update provider records as appropriate when notified of credible allegations of fraud and identify any claims paid during the alleged period.
• Provides assistance with both simple and complex administrative tasks, including but not limited to, entry and validation of data for multiple departments.
• Ensures that provider federal tax information found to be in error as identified through IRS B-Notice is updated.
• Responsible for updating provider configuration as appropriate when notified of an IRS Notice of Levy.
• Reviews provider quality reports and update provider records as appropriate to bring configuration in line with company standards.
• Aids in the development of new policies and procedures needed as new issues arise and assists in creating business and system requirements to improve the management of provider data.
• Performs other position appropriate duties as required in a competent, professional and courteous manner.

Knowledge, Skills, and Abilities:
• Knowledge of claims processing
• Proficiency with Microsoft Excel
• Strong analytical skills
• Experience with Amisys Advance preferred but not required
• Health insurance experience required

Must Have:
• 2+ Years’ Experience
• Associate’s Degree

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