Valid City, State or Zip Code:
Durham
Job Type :
Permanent
Date:
Wednesday, 28 September 2022
Provider Information Analyst - WORK FROM HOME OPPORTUNITY!!
Compile appropriate information to make requested contractual and demographic updates and changes related to provider data in the systems of record in an accurate, complete, and timely manner.
Manage and sustain positive provider relationships.
Configure 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 BCBSNC to external provider communities and internal stakeholder groups.
Pay: 24.28
Hours: 8 am - 5 pm
3 weeks of Training Provided
Work from home opportunity
Job Description:
* Accurately complete provider enrollment, terminations, demo changes and contracts in provider systems of record to ensure appropriate claims payment in accordance with contractual language.
* Compile, analyze, and verify the required information for provider enrollment, contracts, and maintenance for completeness and accuracy, and enter it into the systems of record.
* Communicate, orally and in writing, directly with providers to resolve questions and issues regarding updates and changes in the systems of record.
* Research, respond to, analyze, and resolve complex claims issues related to provider setup and provider eligibility daily. Create resolution documents to address provider issues and increase provider satisfaction.
* Utilize probing and problem-solving methods to resolve all inquiries/requests.
* Identify, understand, and anticipate providers unexpressed needs and concerns. Provide cross functional support and serve as Subject Matter Experts (SMEs) or second tier resolution to internal and external provider teams (i.e., PSA team, Credentialing, Contracting, Provider Service Consultants, 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.
* Perform gap analysis on requests and follows through with communication and/or education to providers on internal BCBSNC process and issues.
* Recommend and participate in process improvement opportunities for PRiMO Operations.
* Identify system problems, gaps, or inconsistencies in workflows and/or processes. Recommend appropriate updates, alternatives, and solutions.
Hiring Requirements
* Associates/Bachelor's degree or certification in business or health related field with demonstration of strong analytical skills in business, systems, or information management (can be through coursework, internships, or relevant work experience).
* MS Office knowledge required
* Ability to adapt to changes quickly
* Can work in a high production environment
* Time Management and Strong Organization skills
* Team Mentality
* Person must be very analytical, good to have provider data knowledge, previous extensive claim background, or a customer service background.
* Data entry is involved in this position BUT this is not a data entry position.