Trillium Community Health Plan · 5 hours ago

Provider Engagement Network Specialist

United States

Full-time

Remote

Mid Level

$22.36/hr - $38.07/hr

3+ years exp

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Responsibilities

Provide support to the external provider representative to resolve provider data issues

Research and effectively respond to provider related issues

Submit provider data entries to resolve provider-related demographic information changes

Initiate and process provider add, change and termination forms

Create and maintain spreadsheets used to produce provider directories for multiple products.

Track, update and audit provider data

Identify adds, deletes and updates to key provider groups and model contract

Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment

Provide assistance to providers with website registration

Facilitate provider education via webinar

Work with other departments on cross functional tasks and projects

Facilitate new provider orientations

Facilitate provider trainings

Performs other duties as assigned

Complies with all policies and standards

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims processingBillingCodingManaged care experienceMedical claimsHealth care knowledgeMedicare knowledgeMedicaid knowledgeSpreadsheet maintenanceProvider educationData auditing

Required

Associate's degree and claims processing, billing and/or coding experience preferred.

Three years of experience in managed care environment, medical provider office, customer service within a healthcare organization, and medical claims.

Knowledge of health care, managed care, Medicare or Medicaid.