Senior Specialist, Provider Network Administration
New
J
JobgetherHealthcare operations
Based in the United StatesFull-TimeSenior
Salary40,851.44 - 88,511.46 USD per year
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Job Details
- Experience
- At least four years of healthcare experience
- Required Skills
- Microsoft ExcelMicrosoft Office
Requirements
- Have at least four years of healthcare experience in claims, provider services, provider network operations, hospital or physician billing, or equivalent relevant education and experience.
- Have hands-on claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
- Be familiar with medical terminology, Current Procedural Terminology (CPT), and ICD-9/ICD-10 codes.
- Demonstrate accuracy in data entry, validation, review, and processing, with strong data integrity and quality practices.
- Bring strong customer service skills and the ability to work effectively with internal stakeholders.
- Organize multiple priorities, meet deadlines, and maintain accuracy under competing demands.
- Communicate effectively in writing and verbally, document procedures, and communicate findings clearly.
- Be proficient with Microsoft Office applications, particularly intermediate-level Microsoft Excel, and relevant business software.
- Query language experience is preferred.
Responsibilities
- Generate, validate, and distribute provider-related data and reports to support network administration and quality improvement.
- Maintain provider information across applicable systems, including demographics, affiliations, and fee schedule attachments.
- Prepare provider directories and reports, including GeoAccess, online, Medicare, FQHC, and RHC reports.
- Produce data extracts and reports related to claims, network management, emergency room activity, network access fees, and mailing labels.
- Review provider data for completeness, accuracy, and alignment with business and system requirements.
- Audit provider records for data quality and financial accuracy, document findings, and provide feedback for corrective action.
- Develop and maintain documentation, procedures, and guidelines for assigned responsibilities.
- Collaborate with relevant teams to troubleshoot provider network configuration issues and support network administration projects.
- Provide guidance, training, and ongoing support to new and existing team members.
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