Provider Engagement Network Specialist

Jobtailor; Deutschland; Remote; EUR 47.000 - 73.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a Provider Data Specialist to ensure accurate setup and ongoing maintenance of provider records across state reporting, claims payment, and directories. You will support external provider reps, research data issues, process demographic changes, and manage provider education via webinars.

The ideal candidate has an Associate's degree with experience in claims processing or billing and at least three years in a managed care or medical office environment, plus knowledge of

Qualifikationen

• Associate's degree; claims processing, billing, or coding experience preferred.
• Three years of experience in a managed care environment or medical office.
• Knowledge of health care, managed care, Medicare or Medicaid.
• Ability to support South Florida: Miami, Broward, Palm Beach.

Aufgaben

• Ensure providers are set up accurately in the provider information system for state reporting, claims payment, and directories.
• Support external provider representatives in resolving provider data issues.
• Research and respond to provider-related issues.
• Submit provider data entries for demographic information changes.
• Initiate and process provider add, change, and termination forms.
• Create and maintain spreadsheets for provider directories across multiple products.
• Track, update, and audit provider data.
• Identify additions, deletions, and updates to key provider groups and model contracts.
• Research claim-payment processing inaccuracies and route them to the appropriate site operations team for adjustment.
• Assist providers with website registration.
• Facilitate provider education via webinar.
• Collaborate with other departments on cross-functional tasks and projects.
• Facilitate new provider orientations and trainings.
• Perform other duties as assigned.
• Comply with all policies and standards.

Kenntnisse

Provider Data Management

Claims Processing

Customer Service

Healthcare Knowledge

Managed Care Experience

Ausbildung

Associate's degree

Jobbeschreibung

• Ensure providers are set up accurately in the provider information system for state reporting, claims payment, and directories
• Support external provider representatives in resolving provider data issues
• Research and respond to provider-related issues
• Submit provider data entries for demographic information changes
• Initiate and process provider add, change, and termination forms
• Create and maintain spreadsheets for provider directories across multiple products
• Track, update, and audit provider data
• Identify additions, deletions, and updates to key provider groups and model contracts
• Research claim-payment processing inaccuracies and route them to the appropriate site operations team for adjustment
• Assist providers with website registration
• Facilitate provider education via webinar
• Collaborate with other departments on cross-functional tasks and projects
• Facilitate new provider orientations and trainings
• Perform other duties as assigned
• Comply with all policies and standards

Requirements

• Candidates must live in Florida
• Associate's degree and claims processing, billing and/or coding experience preferred
• Three years of experience in a managed care environment, medical provider office, customer service within a healthcare organization, and medical claims
• Knowledge of health care, managed care, Medicare or Medicaid
• Ability to support South Florida: Miami, Broward, Palm Beach
• Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Core Competencies

Demonstrates expertise in provider data management, including accurate setup, tracking, and auditing within healthcare systems. Proficient in claims processing and customer service in a managed care environment, with a strong understanding of Medicare and Medicaid regulations.

Highest-signal resume keywords

• Provider Data Management
• Claims Processing
• Customer Service
• Healthcare Knowledge
• Managed Care Experience

ATS Optimization Keywords

Hard Skills

• Claims Processing
• Billing
• Coding
• Data Entry
• Spreadsheet Management
• Provider Education
• Demographic Information Changes
• Provider Orientation
• Data Auditing
• Contract Management

Soft Skills

• Problem Solving
• Collaboration
• Communication
• Research
• Training Facilitation

Certifications & Qualifications

• Associate's Degree

Industry Keywords

• Managed Care
• Healthcare
• Medicare
• Medicaid
• Provider Information System
• Claims Payment
• Provider Directories
• South Florida