Summary
Reviews Provider Records maintained by Tech I. Ensures their eligibility in accordance with network, client and government regulatory guidelines. Ensure accurate updates and maintains provider records within our claims payment systems. Works under general supervision and may provide guidance to lower levels.
Duties
Performs analysis and completes entry into Salesforce for all provider applications and updates including adds, changes, and terminations. Occasionally assists with audit of network provider entry into Facets to ensure accuracy and the integrity of the network provider data. Completes phone verification calls to providers to obtain missing data elements for credentialing and updates as defined by state regulations. Performs routine assignments with minimal supervision.
- Reviews contracted provider data and completes entry into the Salesforce system.
- Verifies provider’s group affiliations.
- Occasionally utilizes NPPES NPI Registry to verify provider NPI and update per NPI website.
- Identifies updates of provider specialty, education, American Board Certification, and state license number and forwards to Credentialing for verification.
- Contacts provider to obtain required data elements to complete provider updates.
- Assists Contract Administrator with maintaining updates to the job aides, makes recommendations for process updates, and maintains updates to the job aides based on recommendations from the Contract Administrator.
- Assists with audit of applications, adds, changes, and terms into the Salesforce and Facets systems and completes audit spreadsheets and provides feed back to the Contract Administrator.
- Reviews and updates error reports received from payers as needed.
- Provides weekly status reports to Contract Administrator to be used for reporting to Supervisor, Provider Relations, and PPO USA.
- Assists with completing provider entry for all applications, adds, changes, and terminations.
- Assists with other tasks as assigned.
Education Requirements
Requires high school diploma or equivalent
Experience Requirements
- Requires three years of data entry or similar clerical experience
- Requires effective written and verbal communications skills to answer questions from staff and respond to inquiries
- Requires alpha numeric entry of 10,000 KPH
- Requires analytic ability to prepare departmental reports and ability to compare data and resolve discrepancies
- Requires proficiency with Word and Excel
Preferred
Salesforce Experience
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. We celebrate diversity and are committed to creating an inclusive environment for all employees.
