79 applicants
TriWest Healthcare Alliance ยท 2 days ago
Provider Data Resolution Specialist
Phoenix, AZ
Full-time
Onsite
Entry, Mid Level
$35K/yr - $45K/yr
2+ years exp
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Insider Connection @TriWest Healthcare Alliance
Responsibilities
Resolves Provider data discrepancies related to claims processing, including contract reimbursement rates within the allotted timeframe.
Manages daily follow up of Provider data correction requests and issues to ensure databases are current and accurate.
Ensures and maintains accurate data within the Provider Claims and Authorization databases.
Contacts providers to verify all credentialing, claims, and billing information.
Ensures appropriate tax documentation is obtained and imaged for Provider files.
Corrects reimbursement issues within claims payment system.
Develops, maintains, and processes reimbursement terms ensuring correct claims payment and downstream processing.
Reviews Provider contract language and identifies when a contract is out of compliance. Processes Provider contracts, run reports, and responds to inquiries regarding contract compliance issues; images and indexes contracts and return images to network subcontractors; conducts quality assurance activities to ensure image quality and completion of image activities. Queries primary sources and OIG, as applicable, to verify Provider credentials and qualifications.
Professionally and concisely communicates in writing and by phone, information and/or instructions for updating and correcting databases.
Resolves 1099 and W9 discrepancies.
Assist in the development and update of protocols and procedures.
Coordinates with Claims and other departments on Provider database related issues.
Resolves daily error reports which include data rejected from claims system including data rejecting from all downstream systems.
Performs other duties as assigned.
Regular and reliable attendance is required.
Qualification
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Required
High School Diploma or GED
2 years of varied responsible experience with computer database programs
2 years of Health Care experience such as claims, provider data or authorization or referral processing
Experience with Microsoft Suite (including, but not limited to, Word, Excel and Outlook)
Must be a U.S. Citizen
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DOD) background adjudication
Preferred
1+ years of Health care claims resolution experience
Experience using a Provider Data Management System, Claims System, or Authorization/Referral system
Benefits
Medical, Dental and Vision Coverage
Generous paid time off
401(k) Retirement Savings Plan (with matching)
Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
Tuition reimbursement
Paid volunteer time
Company
TriWest Healthcare Alliance
TriWest Healthcare Alliance - Serving Those Who Serve. At TriWest, we honor the sacrifice and service of our nations military families by
1,001-5,000 employees
Funding
Current Stage
Late StageLeadership Team
Mark E. Babbitt
Senior Advisor to President & CEO
Joseph Oddo
Vice President and Chief Information Officer
Recent News
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