IT/Software/Technology

Provider Information Specialist I

Contract

Strategic Staffing Solutions

Job Title: Provider Information Specialist (208854)
Location(s): REMOTE
Duration: 6 Months

S3 supports and adheres to customer COVID-19 vaccination policies, which may include the disclosure of vaccination status.

This is a Contract Opportunity with our company that MUST be worked on a W2 ONLY, NO C2C eligibility for this position.

To apply: Please email your resume inWord FormattoPaola Martinez at: PMartinez@strategicstaff.comand Reference Job Order #:208854

Job Description / Duties: Compile appropriate information to make requested credentialing, contractual, and demographic updates and changes related to provided data in the systems of record in an accurate, complete, and timely manner. Manage and sustain positive provider relationships. Setup providers and networks in systems of record, assign provider numbers and communicate with provider community. Facilitate accurate financial claims payment and provider directory processes. Represent the company to external provider communities and internal stakeholder groups.

  • Accurately setups providers in provider systems of record to ensure appropriate claims payment in accordance with contractual language.
  • Compiles, analyzes, and verifies the required information for provider enrollment, contracts, and maintenance for completeness and accuracy, and enter it into the systems of record.
  • Communicates, orally and in writing, directly with providers to resolve questions and issues regarding updates and changes in the systems of record.
  • Researches, responds to, analyzes and resolves complex claims issues related to provider setup and provider eligibility on a daily basis.
  • Creates resolution documents to address provider issues and increase provider satisfaction. Utilizes probing and problem solving methods to resolve all inquiries/requests. Identifies, understands and anticipates providers unexpressed needs and concerns.
  • Provides cross functional support and serves as subject matter resource or second tier resolution to internal and external provider teams (i.e., Contracting, Provider Relations, etc).
  • Manage timely responses to external provider inquiries and requests. Evaluate new service requests from providers to determine appropriate actions for recording into the systems of record.
  • Recommend, and participate in process improvement opportunities for Network Management Operations.
  • Identify system problems, gaps or inconsistencies in workflows and/or processes. Recommend appropriate updates, alternatives. 
  • Accountable for complying with all laws and regulations associated with duties and responsibilities.
  • The physical demands described here are representative of those that must be met by an employee to successfully perform the accountabilities (essential functions) of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.
  • Job duties are performed in a normal and clean office environment with normal noise levels.
  • Work is predominately done while standing or sitting.
  • The ability to comprehend, document and analyze are all required.

Required Qualifications:

  • High School diploma or equivalent is required. Prefer an Associate or Bachelor’s degree in business or health related field
  • Two years of customer service, credentialing, enrollment and billing, claims and/or insurance operations experience is required.
  • Demonstrated knowledge of insurance services and operations.

Hiring Preference:

  • Facets, IPD, Provider Manager, and Cactus knowledge preferred.
  • Prior claims processing experience preferred.
  • Strong analytical skills/problem solving skills.
  • Critical thinking/ability to question.
  • Provider (customer) focused.
  • Interpersonal skills/relationship building.
  • Excellent communication skills with internal and external stakeholders; ability to effectively communicate with provider community in a professional manner.
  • Ability to multitask in a fast-paced production environment.
  • Strong organizational skills/Time management.
  • Takes accountability for work performed.
  • Ability to work both individually and in a team environment with shared goals.
  • Ability to work under pressure to produce high quality work with defined turnaround goals.
  • Ability to effectively adapt to change.

 

Strategic Staffing Solutions (S3) prides itself on being an international IT Staffing and Solutions Company. Over 30 years’ experience recruiting and managing exceptional IT and Business consultants for customers in the Financial, Energy, Public Sector and Retail Distribution industries. A privately held, financially strong, woman-owned company, S3 is a full-service IT firm, with 24 major market locations in the U.S!

Job ID: JOB-208854
Publish Date: 28 Oct 2022

Tagged as: Provider Information Specialist I