Provider File Representative Senior
Nashville Staffing, Nashville, Tennessee, United States, 37201
Job Title: Corporate Provider Enrollment And File Maintenance
This position is responsible for corporate provider enrollment and provider file maintenance across all markets. This includes, enrollment, contracting and demographic provider information. Incumbent ensures compliance with BCBS and CMS requirements, DOH regulations, internal, private business and governmental audits. Responsible for reviewing and processing additions, updates, and deletions of provider information in the Provider File database. Ensures executions of data entry and updates are completed in a timely and accurate manner. Essential Responsibilities: Maintain accurate data in provider file data systems. Maintaining and initial setup of assignment accounts (AA) from the AA applications Updating group and provider affiliations from AFBs and written requests 1099 tax ID updates UPIN/PTAN and/or Medicare Welcome Letter information State license update Enumerating providers Name changes, demographic data updates, specialty changes Hospital affiliations, network affiliations, network terminations Facility Agreement data, Institutional non-contracted files. File Maintenance Analysis. Applying complex and detailed guidelines in the review process of the submitted requests Routinely contact external sources such as the Provider offices, state licensing agencies and provider reps to collect or clarify information or documentation, which in turn must be reviewed and evaluated against the established guidelines Ensure the file meets all regulations prior to updating the provider file Data Integrity. Contact external sources to collect or clarify information or documentation which in turn must be reviewed and evaluated against the established guidelines and procedures to ensure the file meets all policy and procedures in conjunction with regulations. Qualifications: Minimum: High School Diploma or GED, 5-10 years of related, progressive experience Physical, Mental Demands and Working Conditions: Position Type: Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. Pay Range Minimum: $22.71 Pay Range Maximum: $35.88 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org Req ID: J274982
This position is responsible for corporate provider enrollment and provider file maintenance across all markets. This includes, enrollment, contracting and demographic provider information. Incumbent ensures compliance with BCBS and CMS requirements, DOH regulations, internal, private business and governmental audits. Responsible for reviewing and processing additions, updates, and deletions of provider information in the Provider File database. Ensures executions of data entry and updates are completed in a timely and accurate manner. Essential Responsibilities: Maintain accurate data in provider file data systems. Maintaining and initial setup of assignment accounts (AA) from the AA applications Updating group and provider affiliations from AFBs and written requests 1099 tax ID updates UPIN/PTAN and/or Medicare Welcome Letter information State license update Enumerating providers Name changes, demographic data updates, specialty changes Hospital affiliations, network affiliations, network terminations Facility Agreement data, Institutional non-contracted files. File Maintenance Analysis. Applying complex and detailed guidelines in the review process of the submitted requests Routinely contact external sources such as the Provider offices, state licensing agencies and provider reps to collect or clarify information or documentation, which in turn must be reviewed and evaluated against the established guidelines Ensure the file meets all regulations prior to updating the provider file Data Integrity. Contact external sources to collect or clarify information or documentation which in turn must be reviewed and evaluated against the established guidelines and procedures to ensure the file meets all policy and procedures in conjunction with regulations. Qualifications: Minimum: High School Diploma or GED, 5-10 years of related, progressive experience Physical, Mental Demands and Working Conditions: Position Type: Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. Pay Range Minimum: $22.71 Pay Range Maximum: $35.88 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org Req ID: J274982