Primary Job Duties and Responsibilities:
- Ensure that all required data such as NPI, License, primary specialty, taxonomy code, OIG LEIE, certifications and accreditations are researched and recorded in the appropriate fields of the provider record.
- Ensure that the provider data entered meets the format standards set by AZPC.
- Run reports to identify providers and vendors records that do not meet the established data or format requirements.
- Run SQL queries in EzCap to identify claims requiring provider or vendors additions.
- Update provider contract status information upon receiving notice of contract effective date or contract termination date.
- Run reports to identify claim errors that require provider data update for error resolution, including but not limited to Providers Health Plan Panel is not in effect on Service Date or Provider Contract Not in Effect on Date of Service.
- Maintain knowledge and understanding of contracts, Division of Financial Responsibility (DOFR), Network Areas and coverage area.
- Update vendor remittance addresses as required. Document the source of the updated information in the vendor notes. Valid sources include notification from the provider, forwarding orders received from the USPS and forwarding address information received from RedCard.
- Note the receipt of a W9 in the vendor notes. Compare Business Name, mailing address and SSN/EIN information on the W9 with the information entered in EzCap. Make changes if required in EzCap and have the W9 scanned to Document Management.
- Run reports and add/edit data in a timely manner.
- Other duties and projects as assigned.
- High school diploma or equivalent.
- Minimum of one year experience using EzCap, ExCel and Crystal Reports. Minimum of one year experience processing claims.
- Minimum of one year experience in the medical or health related field.
- Knowledge of Medicare rules, medical terminology, and managed care health plan rules and regulations, contracts, DOFR’s, ICD-9, CPT and RVS codes.
- Must be proficient in typing and detail oriented.
- Ability to work independently and under pressure.
- Ability to interact effectively with patients and professionals.
Job Type: Full-time
Work Location: In Office/Hybrid after 90 days. Not a fully remote position
To apply for this job email your details to firstname.lastname@example.org