Remote Provider Data Integrity Specialist

TriWest Healthcare Alliance; Phoenix (AZ); On-site; USD 44,000 - 48,000; Full time

Benefits offered by this job

Medical, Dental and Vision Coverage

401(k) Retirement Savings Plan (with 2

Paid time off

Short-term and long-term disability

Tuition reimbursement

Paid volunteer time

Job summary

TriWest Healthcare Alliance in Phoenix is seeking a data coordinator to maintain Provider data across Claims, Data Management, and Authorization systems. You will verify information, perform basic credentialing tasks, and communicate with providers to resolve data issues, working under production targets.

Candidates should have a high school diploma or GED, US citizenship for TRICARE work, and solid experience with database software and Microsoft Office. A background check will be required.

Qualifications

• High School Diploma or GED
• U.S. Citizenship required for TRICARE contract
• Ability to receive a favorable Interim and adjudicated final DOD background adjudication
• 2 years of varied responsible experience with computer database programs
• 2 years of Health Care experience such as claims, provider data or authorization or referral processing
• Experience with Microsoft Suite (including Word, Excel and Outlook)

Responsibilities

• Resolves Provider data discrepancies related to claims processing.
• Manages daily follow up of Provider data correction requests and issues to ensure databases are current and accurate.
• Ensures and maintains accurate data within the Provider Claims and Authorization databases.
• Contacts providers to verify all credentialing, claims, and billing information.
• Ensures appropriate tax documentation is obtained and imaged for Provider files.
• Corrects reimbursement issues within claims payment system.
• Develops, maintains, and processes reimbursement terms ensuring correct claims payment and downstream processing.
• Reviews Provider contract language and identifies when a contract is out of compliance.
• Professionally communicates in writing and by phone to update and correct databases.
• Resolves 1099 and W9 discrepancies.
• Assist in the development and update of protocols and procedures.
• Coordinates with Claims and other departments on Provider database related issues.
• Resolves daily error reports from claims system and downstream systems.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Skills

Microsoft Suite

Tools

Microsoft Suite

Job description

TriWest Healthcare Alliance in Phoenix is seeking a data coordinator to maintain Provider data across Claims, Data Management, and Authorization systems. You will verify information, perform basic credentialing tasks, and communicate with providers to resolve data issues, working under production targets.

Candidates should have a high school diploma or GED, US citizenship for TRICARE work, and solid experience with database software and Microsoft Office. A background check will be required.